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Tue, 14 Aug 2018 17:01:00 +0200

Samir Amin: vital challenge to dispossession – Global capitalism, centre, peripheries, de-linking

Samir Amin’s ideas were formed in the heady ferment of 1950s and ’60s, when pan-Africanists like Kwamah Nkrumah ran Ghana and Julius Nyrere Tanzania, when General Nasser was transforming the Middle East from Amin’s native Egypt and liberation movements thrived from South Africa to Algeria.

Africa looked very different before the International Monetary Fund destroyed what progress had been made towards emancipation and LiveAid created a popular conception of a continent of famine and fecklessness. Yet through these times, Amin’s ideas have continued to shine out, denouncing the inhumanity of contemporary capitalism and empire, but also harshly critiquing movements from political Islam to Eurocentric Marxism and its marginalisation of the truly dispossessed.

 Global power

Amin believed that the world capitalism – a rule of oligopolies based in the rich world – maintains its rule through five monopolies – control of technology, access to natural resources, finance, global media, and the means of mass destruction. Only by overturning these monopolies can real progress be made.This raises particular challenges for those of us who are activists in the North because any change we promote must challenge the privileges of the North vis-à-vis the South.

Our internationalism cannot be expressed through a type of humanitarian approach to the global South – that countries in the South need our ‘help to develop’. For Amin, any form of international work must be based on an explicitly anti-imperialist perspective. Anything else will fail to challenge structure of power – those monopolies which really keep the powerful. Along with colleagues like Andre Gunder Frank, Amin sees the world divided into the ‘centre’ and the ‘peripheries’.

The role of peripheries, those countries we call the global South, is to supply the centres – specifically the ‘Triad’ of North America, Western Europe and Japan – with the means of developing without being able to develop themselves. Most obviously, the exploitation of Africa’s minerals on terms of trade starkly favourable to the centre will never allow African liberation, only continual exploitation.

This flies in the face of so much ‘development thinking’, which would have you believe that Africa’s problems come from not being properly integrated into the global economy which has grown up over the last 40 years. Amin believes in fact Africa’s problem stem from it being too integrated but in ‘the wrong way’. In fact, as long as the monopolies of control are intact, countries of the centre have had few problems globalising production since the 1970s.

Sweatshop labour now takes place across the periphery but it hasn’t challenged the power of those in the North because of their control of finance, natural resources, the military and so on. In fact, it has enhanced their power by reducing wages and destroying a manufacturing sector that had become a power base for unionised workers.So there is no point whatever in asking countries of the centre to concede better trading relationships to the peripheries.

Amin is also concerned at environmental activism which too often becomes a debate about how countries of the centre manage their control of the world’s resources, rather than challenging that control. It is vital that Northern activists challenge the means through which the ruling class in their own society exerts control over the rest of the world.

 De-linking

Of course, this is not just a project for activists in the North – far from it. The theory for which Amin is most famous that of ‘de-linking’. De-linking means countries of the periphery withdrawing from their exploitative integration in the global economy. In a sense it is de-globalisation, but it is not a form of economic isolation – something which African socialist leaders too readily fell into. Rather it means not engaging in economic relationships from a point of weakness.

Amin argues that Southern countries should develop their economy through various forms of state intervention, control of money flowing in an out of their financial sectors and promoting trading with other Southern countries. Countries must nationalise financial sectors, strongly regulate natural resources, ‘de-link’ internal prices from the world market, and free themselves from control by international institutions like the World Trade Organisation. Whatever problems come with nationalised industries, it is the only possible basis for a genuinely socially controlled economy going forward.

After 30 years of being told that their problems would be solved by exporting more, privatising their natural resources and liberalising their financial sectors, many developing countries would today do well to heed Amin’s advice. Instead, too many countries have bought into a de-politicised narrative which posits ideologically loaded terms like ‘good governance’, ‘poverty’ and ‘civil society’ carefully disguising questions as to how poverty happened, what interests governance serves, or the legitimacy of organisations claiming to speak on behalf of the dispossessed.

Amin did not believe that the ‘rise’ of China, India and other emerging economies has in any way broken the power of the oligopolies, in fact that power has only become more concentrated. But there have been important changes. Imperialist powers have realised competition between themselves is not helpful and have created a sort of collective imperialism which is expressed through institutions like the WTO and IMF.

 Capitalism, ‘a parenthesis in history’

Capitalism is experiencing a profound long-term crisis to which Amin believes it has no solution short of political barbarism. He describes this form of capitalism as ‘senile’.This crisis is characterised by an increased dependence on finance, which means less and less money is being made from productive activities, and more from simple ‘rent’. It is a far more direct means of stealing wealth from the majority of the world. The accompanying form of politics means that democracy has been reduced to a farce in which people are spectators in an elite drama – that is when they’re not fulfilling their proper role of consuming.

Capitalism necessarily requires an ongoing process of dispossession so that it can accumulate and continue to expand. Capitalism could not have developed without the European conquest of the world – the availability so many ‘spare’ resources was vital.

The safety value for many of those dispossessed from European land was the ‘new world’ which allowed mass emigration – though of course others died in droves, witness the Irish potato famine. So as much as many of the dispossessed might aspire to the lives of those in advanced capitalist countries, it is simply not possible. Nor can traditional Marxists be correct when they say capitalism is a necessary stage on the path to socialism – a view which Amin describes as ‘Eurocentric’.

Industry cannot incorporate more than a small fraction of humanity, but it does require the resources that that humanity depends upon. So the only way that capitalism can move forward is through the creation of a ‘slum planet’ – a sort of ‘apartheid at the world level’.

Amin sees the dispossession of the peasantry across the peripheral countries will become the central issue of the twenty-first century.This is one reason why Amin see the role of the peasantry in the South – almost half of humanity after all – as key to determining the future. The strength of movements around food sovereignty, against land grabbing and supporting the rights of indigenous peoples, give support to this theory.

But for Amin, agriculture is not merely a big opportunity, the existence of the peasantry presents capitalism with an insurmountable challenge.Amin believes the road to socialism depends on reversing this trend of dispossession meaning, at national and regional levels, protecting local agricultural production, ensuring countries’ have food sovereignty and de-linking internal prices from world commodity markets. This would stop the dispossession of peasants and their exodus into the towns.

Only this revolution in the way the land is seen, treated and access can lay the basis for a new society. This also means ditching the idea of ‘growth’ as it is spoken about today and by which all world economies are judged, which really benefits only a minority of the world population. The rest of humanity is “abandoned to stagnation, if not pauperisation”.

 The long road to socialism

Perhaps this makes Samir Amin sounds rather idealistic in his approach, but this is far from true. Amin explicitly rejects the idea of a ‘24 hour revolution’ – a single insurrectionary act which ushers in a period of socialism. Indeed he accepts there may well be a need to use private, even international capital, in order to diversify Southern economies. The important thing is control. For this reason Amin also refuses to use the phrase “socialism of the 21st century” focussing on the need for “the long route of the transition to socialism”.

But that’s not to say there have not been significant victories. Interestingly, Amin is less interested in developments in Latin America, which he believes contain risks of repeating the mistakes of many national liberation movements on the 1950s and 60s in becoming a form of “popular statism”. Amin is more interested in Nepal as an possible future model to look towards. He also sees the Chinese revolution as an incredibly significant event in directly challenging the basis of capitalism and in the struggle for democratic socialism, most especially in its “abolition of the private property of land” and the formation of powerful communes and collectives.

Amin’s somewhat romantic view of the Chinese revolution is certainly challenging to Western sensibilities, but his underlying view that the formation of democracy must go beyond a narrow political project, and that peasants – and especially women – through collective organisations, might be better placed than Western individualists to define a really progressive vision of democracy needs to be properly taken on board by activists.

 Enlightenment

Perhaps Amin’s central thesis is somewhat obvious, but it’s often forgotten – that a true revolution must be based on those who are being dispossessed and impoverished. But he goes further in undermining the assumption that any thinking emerging from the South will lack enlightenment, or that a lack of enlightenment should be excused.

He believes the Enlightenment was humanity’s first step towards democracy, liberating us from the idea that God created our activity. He has caused controversy in his utter rejection of political Islam. This ideology, embedded for example in Egypt’s Muslim Brotherhood, obscures the real nature of society, including by playing into the idea that the world consists of different cultural groups which conflict with each other, an idea which helps the centre control the peripheries.

 Creative Marxism

Samir Amin decribes himself as a ‘creative Marxist’ – “to begin from Marx but not to end with him or with Lenin or Mao” which incorporates all manner of critical ways of thinking even ones “which were wrongly considered to be ‘alien’ by the dogmas of the historical Marxism of the past.” These views are surely more relevant today than when Amin started writing.

A creative Marxism takes proper account of the perspective and aspirations of the truly dispossessed in the world, break out of historical dogmas and rejects attempts to stick together a broken model, but equally sees the impossibility of overthrowing this model tomorrow.

Nick Dearden (director of Global Justice )


DEARDEN Nick

Tue, 14 Aug 2018 10:27:00 +0200

India: Maoist Leader Kobad Ghandy's Health Alarm in Jharkhand Jail

Ghandy has alleged that prison authorities and the police have been ignoring his worsening health condition.

New Delhi: Kobad Ghandy, the imprisoned Maoist ideologue, has said that his health has deteriorated as prison authorities have not followed the doctor’s advice to send him to Ranchi for treatment, a report in the Telegraph said. The 71-year-old activist, in Jharkhand prison, is facing trial for a 2007 attack.

He was moved from Tenughat sub-divisional jail in Bokaro to Loknayak Jai Prakash Narayan Central Jail in Hazaribagh in March.

“The latest urine/blood report for the prostrate/urinary (July 3, 2018) tract shows a serious deterioration in the condition,” Ghandy has said in a letter dated July 7, addressed to human rights activist and JNU professor Moushumi Basu.

“Ever since arrest by the Jharkhand police I have been informing that this condition is serious and continuously deteriorating. But the authorities have totally ignored it.”

Ghandy, who has been part of the central committee and politburo of the CPI(Maoist) since its inception in 2004, was arrested by the Andhra Pradesh police from New Delhi in 2009. He was released on bail from Vishakhapatnam central prison in December 2017. However, he was re-arrested a few days later.

Ghandy suffers from hypertension, arthritis, a slipped disc and has been treated for prostate cancer, the Telegraph report said.

Earlier, Ghandy was lodged in Cherlapalli central jail on the outskirts of Hyderabad in connection with the assassination of former Congress MLA Chittem Narsi Reddy in August 2005. Prior to that, he had also spent seven years in Tihar jail in Delhi.

Kobad Ghandy had also been named in a conspiracy case pertaining to an attack on a team of elite anti-Maoist commando unit Greyhounds at Gunurkayi village in Visakhapatnam in 2008, for which he was booked under the Explosive Substances Act and Unlawful Activities (Prevention) Act.

Human rights and civil rights activists have been drawing attention to the treatment of political prisoners in jail. At a recent event in the Capital last week, writers, lawyers and activists demanded the release of wheelchair-bound Delhi University professor G.N. Saibaba.

Saibaba was arrested for alleged links with Maoists. Last year, he was sentenced to life imprisonment. This June, United Nations Rights experts in a joint statement said, “We are concerned about reports that Saibaba is suffering from more than 15 different health problems, some of which have potentially fatal consequences.”


The Wire Staff

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The Wire Staff

Tue, 14 Aug 2018 10:27:00 +0200

The brutal personal costs of the Philippines' human rights abuses

The 18-year-old had been a recreational drug user but as far as his family knew, hadn’t used in a few years. Yet the father of two had still become ensnared in the increasingly brutal drug war of President Rodrigo Duterte, whose government has been killing suspected drug users and “drug pushers” since 2016. Duterte recently announced he was ramping up his efforts.

Sheerah, a diminutive woman in her early 20s with a bright smile, bears the trauma of her brother’s death with stoicism. Her Facebook page is a mix of joyful pictures with friends at coffee shops, juxtaposed with photos of her brother’s bloodied body lying in the street.Sheerah and her family tried to identify those responsible for Ephraim’s death. They reported his disappearance immediately to police. Local police departments have refused to release any information or leads. Witnesses have told Sheerah that Ephraim was picked up by two men on a motorcycle, a common killing tactic now known as “riding in tandem.” CCTV footage confirmed this.

His death made the impact of the drug war personal in the most visceral sense — a brother lost, a father taken too soon.

Human rights workers targeted

We met Sheerah in late April 2018, during a trip to the Philippines to investigate the deteriorating human rights situation in the country — part of a broader research project at the International Human Rights Program, University of Toronto Faculty of Law, to understand Canada’s role in the region.

Sheerah’s story is all too common. The Duterte government’s brutal crackdown on drugs continues unabated. Duterte has publicly galvanized the Philippine National Police force to “slaughter them all,” proclaiming that we “can expect 20,000 to 30,000 more” deaths before the war is over.Our conversations with more than 50 human rights defenders, environmental activists, lawyers, artists and Indigenous groups revealed troubling patterns in a country that’s increasingly closing its borders to outsiders.

As with any state directly targeting its own people, actual numbers are difficult to quantify, but Human Rights Watch estimates there are more than 12,000 dead. The body count rises daily; victims include children and young people like Sheerah’s brother Ephraim. Their deaths destroy families and the social fabric of communities.

The lawyers and organizations we spoke with in metropolitan Manila all mentioned numerous colleagues who have been placed on this list, with some detained by the regime, while others have ominously disappeared.Sheerah’s story shows the profound and far-reaching reverberations of state-induced violence. This violence takes many forms. For example, the regime has been explicitly targeting human rights advocates, placing many lawyers, NGO workers and environmental activists on a “suspected terrorist” hit list, which the government filed at a Manila Court in March 2018.

Mining and degradation of the environment

The hit list has also created a climate of fear among environmental activists who have been advocating for agrarian reform, basic human rights for farmers, as well as highlighting environmental degradation as a result of extractive mining activities across the country.

During our time in rural Santa Cruz in the province of Zambales, we interviewed numerous environmental activists and farmers who spoke about the inaction of the government to address the tremendous environmental impacts of a neighbouring nickel mine.

The mine has destroyed rice paddies, polluted rivers and ocean water, killed livestock, and made it extremely difficult for farmers and fisherfolk to sustain their livelihoods.

The community’s incredible hospitality during our stay was contrasted by the stark poverty as a result of ongoing mining in the region. Many farmers and activists also expressed fatigue at having to deal with more researchers who ultimately do nothing to help their situation.

As one farmer told us: “I don’t want to talk to another Westerner ever again — nothing is changing. Your mines come in, our government sells away our lives, and we are left with nothing.”

While Canada is not operating a mine directly in Zambales, the deteriorating security situation at the time of our fieldwork did not allow us to visit Canadian mining sites as we had initally planned in the southern island of Mindadao, or the Oceana Gold mining facility in Didipio in central Luzon, which has already faced strong criticism by environmental groups in Canada.

Canadian mines also devastate the environment

However, the environmental impacts we observed in Santa Cruz are apparently similar to those at the Oceana Gold mine, according to representatives of the Didipio community as well as environmental activists in Manila who regularly monitor Canadian mines.

In Mindanao, thousands have been displaced by the mining activity and the counter-insurgency war, including numerous Indigenous peoples, who are often also directly targeted and murdered by the Duterte government for speaking out.

According to an Indigenous Lumad chieftain, Datu Lala: “Mindanao is now so militarized that we cannot breathe. We have to get out — otherwise we will be killed.”

The chieftain and his community have been seeking sanctuary in Manila for the last few months after a number of their family members, including children, were killed. Communities such as the Lumad are increasingly afraid to speak out for fear of reprisal, and environmental activists do not want to become the next target.

The Duterte government has also undermined fundamental democratic institutions and the independent judiciary, removing Maria Lourdes Sereno, the chief justice of the Philippine Supreme Court, and publicly attacking the Commission on Human Rights, an independent and constitutionally mandated body that monitors and investigates human rights in the Philippines.

Duterte has even threatened to slash its annual Human Rights Commission budget to a mere $20 and has called its chairman, Chito Gascon, a “pedophile” on national television.

Duterte doesn’t stop with his own people.

His administration has also been sealing its borders to international observers, and he’s barred foreigners like the Italian politician Giacomo Filibeck and a delegation from entering the country in April.

Even religious missionaries are not immune. During our time in the Philippines, Duterte ordered the expulsion of 76-year-old Australian nun Sister Patricia Fox, who has been living in the country for 20 years, for so-called “human rights activism.”

And the United Nations Special Rapporteur for the right of Indigenous peoples, Victoria Tauli-Corpuz, has been placed on the suspected terrorist list and is now afraid to return to the Philippines.

Our fieldwork was marred by this increasingly hostile environment. We were repeatedly told to keep a low profile, and our sources warned us that the government does not like foreign criticism.

Canada must do better

As two Canadian lawyers specializing in human rights law, we were profoundly disturbed by the discrepancy between this reality on the ground and Canada’s silence on the Philippines.

The International Criminal Court has initiated a preliminary investigation against Duterte himself, and the president retaliated by calling for a complete withdrawal from the court and threatening to arrest its chief prosecutor, Fatou Bensouda, if she ever dared to set foot in the Philippines.

However, during our visit to the Canadian Embassy in Manila, a spokesperson emphasized Canada’s insistence on maintaining “friendly relations” with the Philippines.

It’s possible that Canada benefits from these friendly relations. We import labour from the Philippines through its many temporary foreign worker schemes. Perhaps calling out human rights abuses in the Philippines would not bode well for maintaining a steady stream of labour that bolsters the Canadian economy.At the absolute minimum, however, Canada must critically re-examine its foreign aid policy and trade relations with the Philippines, such as the recently cancelled $300 million helicopter deal, which would have sent 16 combat-ready helicopters to the Philippine military were it not for backlash by the Canadian public and the media.

However, in April 2018, there were renewed discussions about the sale of the same helicopters, as well as an additional helicopter going directly to the Philippine National Police in June this year  — the very same police force perpetrating the drug war murders.

Sheerah is particularly disturbed that “Duterte has made it OK to tell people that it is normal to kill, that people should die for using drugs instead of having access to treatment and rehabilitation.”It’s hard to reconcile Canada’s rhetoric of upholding international human rights with the suffering of people like Sheerah, who lost her only brother to the drug war.

To deal with her trauma, Sheerah has become an activist and writer, volunteering with Rise Up, a network of organizations advocating against the drug-related killings.

Ephraim’s death continues to reverberate through her life in unexpected ways, acting as an “ice-cold” wakeup call, but one that also makes her life more dangerous. Keeping her brother’s memory alive makes her a target, she says, with a mix of quiet resignation and courage: “If this bloodshed continues, we are all potential victims here.”


Petra Molnar and Anna Su

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MOLNAR Petra, SU Anna

Tue, 14 Aug 2018 10:27:00 +0200

UK: London cleaners strike — new unions, new tactics

Workers at the Ministry of Justice and Kensington and Chelsea council plan walk out over conditions

Cleaners at the Ministry of Justice and Kensington and Chelsea council are set to take unprecedented strike action this week in their fight for the London living wage and decent sick pay.

On Tuesday, cleaners will walk out simultaneously across five different sites for three days in what is being heralded as the first coordinated strike by the capital’s vast low-paid army of largely migrant cleaners. The workers hope the strike will pile pressure on the public institutions they claim are refusing to take responsibility for low wages paid to outsourced cleaning staff.

Fatima Djalo, 54, who has been working at the MoJ for five years, said she struggled to live on the £7.83 an hour minimum wage – which the former chancellor George Osborne rebranded as the “national living wage” – in London. “You have to find a way to survive,” she said on her lunch break outside the 56-floor brutalist fortress that houses the MoJ and the Her Majesty’s Courts and Tribunals Service. “But £7.83 an hour is not enough. You have to pay rent. You have to pay bills. You have to pay transport.”

Djalo earns just over £1,000 a month. Well over half of that goes on a single room in Stratford and her travel. She is left with around £400 a month for bills, clothes and food – as well as supporting her son in Portugal. “We are going on strike so we can live, not just survive,” she said.

The strikers are asking for the £10.20 an hour London living wage, which is based on the cost of living in the capital. They are also hoping to raise the issue of sick pay, which they do not receive for the first three days of absence and which thereafter is statutory sick pay of £18 a day.

Osvaldo de Oliveira, 59, recently had to take seven days of leave when he had an operation. “You are always praying to God that you are not going to get too sick to work,” he said.

Although they are employed by the facilities company OCS Group, the cleaners claim the MoJ is ultimately responsible for their pay. “The companies always say we can’t change your pay because it is in the contract with the MoJ,” said De Oliveira.

Workers cleaning Kensington and Chelsea town hall, who are employed by Amey, a private contractor, have the same complaints. They, too, are paid below the London living wage and are denied sick pay for the first three days. Alexandra Muñoz, who trained as a doctor in Colombia, said it was hard to buy everything she needs for her two-year-old daughter because the wages are so low. “It is really difficult to get to the end of the month with more than about £2 or £3 in the bank,” she said outside the town hall. “Sometimes we have to use credit cards to buy food.”

Her colleague, Nestor Rueda, added that they were striking for decent pay but, above all, for dignity: “We are considered the worst of the worst. But we want to be seen as equals.”

As well as Tuesday’s strike, cleaners from eight exclusive private hospitals and medical centres, run by the health firm HCA UK, are set to join further coordinated action at the end of the month. The HCA UK cleaners are also paid below the London living wage but have more specific complaints.

The strike has been organised by the United Voices of the World union. Its founder, Petros Elia, said the MoJ, Kensington and Chelsea council and HCA UK had so far refused to talk to him directly about their demands. “They are taking no responsibility for what happens in their buildings,” he said.

Despite its size, the UVW has notched up a series of impressive victories. It has won the living wage, sick pay and holiday pay for cleaners all over London, including at the Daily Mail’s offices, Sotheby’s and the London School of Economics.

The MoJ said: “The MoJ cleaners are valued colleagues. The national living wage has helped deliver the fastest wage growth for the lowest paid in 20 years, and the most recent rise in April meant fulltime workers will earn an extra £600 a year. We strictly enforce the living wage in all our contracts but specific pay and terms are for employers to agree directly with their employees.”

OCS Group said it would not be commenting.

A Kensington and Chelsea Council spokesperson said: “These cleaners are employed by Amey and we don’t control what Amey pays their staff, though we do expect them to pay their staff appropriately.”

An Amey spokesperson said: “Our contract with the Royal Borough of Kensington and Chelsea predates the voluntary London living wage, so Amey is paid on the basis of the National Minimum Wage.”

HCA UK said it was unable to comment on the terms of employment of “colleagues not employed by HCA UK”.


Tom Wall

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WALL Tom

Tue, 14 Aug 2018 10:12:00 +0200

Welcome to the Next Deadly AIDS Pandemic

The world thought it had fought the HIV virus to a stalemate—but its strategy was flawed in ways that are only now becoming clear.

The world’s experts on HIV/AIDS are gathered this week in Amsterdam for the 22nd International AIDS Conference as a collective anxiousness has set in. The 2016 optimism that fueled a United Nations declaration that the end of AIDS was near has been replaced by a gnawing fear among experts. If properly treated with available drugs, today’s 37 million infected people no longer face mortal illness as did their counterparts in the pre-treatment days of the 1980s and 1990s. That much is true.

But given the rest of the equation, it’s remarkable that the mood in Amsterdam isn’t one of panic. Danger surely looms.

For years, humanity had the virus on the run, and death tolls plunged to joyously low levels. But the disease is now poised, for the first time in recent memory, to add massively to its global death toll of 35 million since 1981. Three factors are contributing to its runaway resurgence: flawed public health strategy, rapidly shifting demography, and diminished resources.

A flawed strategy for HIV control

Let’s start with strategy. In 1996, researchers from multiple institutions and pharmaceutical companies announced the discovery that a combination of drugs, taken daily, could drive HIV levels down so dramatically that the treated individuals could live normal lives. And more than a decade ago, it was shown that the anti-HIV drugs worked so well that viruses were forced into hiding in parts of the body from which they couldn’t spread to other people sexually, through shared needles or blood, or in utero from mother to child.

worldwide strategy for HIV control was set upon, aiming to place all HIV-positive people on the drugs, both to spare their lives and to stop the spread of the virus. The year 2030 was set as the world’s deadline for halting the spread of HIV, stopping AIDS deaths, and having the first generation since 1980 born and raised completely free from infection. To make the dream a reality, a cocktail of anti-HIV drugs was manufactured cheaply, bringing the annual cost down from a 1996 high of well over $10,000 per person to less than $75. And a multibillion-dollar infrastructure was created to find infected individuals, provide them with those drugs, and monitor their health.

But the strategy was a gamble. The drugs didn’t cure anybody—HIV still lurks in the bodies of the nearly 22 million treated individuals. Any interruption in taking the medicine allows hidden viruses to flood into the individual’s bloodstream, endangering the health and survival of the patient and making him or her a contagious risk to others. War, a transport breakdown, government financial glitches, loss of international donor support, patient migration, individual forgetfulness—hundreds of personal, financial, and political factors can interrupt treatment.

Moreover, 15 million people are still untreated and therefore infectious to others. Worse, most of these individuals are unware that they carry the virus, do not see any reason to get a HIV test, and are unlikely to take precautions to protect others, such as using condoms during sex. As a result, the pandemic is continuing to grow. Last year, 940,000 people died of HIV-related causes, while 1.8 million were newly infected with HIV.

And new infections are increasingly showing up in forms that are very hard to treat because the strains of HIV spreading today are more likely to be resistant to those $75-a-year treatments. Drug resistance forces the use of more expensive medicines, and the supply chain for second- and third-line treatments in poorer countries is minimal, in some cases nonexistent. When an individual is infected with a strain of HIV that is already resistant to available drugs, all aspects of the patient’s treatment and survival are affected.

Between 2014 and 2016, the World Health Organization (WHO) surveyed new infections in 11 poor countries, finding in six of the countries more than 10 percent were drug resistant. A 63-nation survey funded by WHO and the Bill & Melinda Gates Foundation found anywhere from 6 to 11 percent of new infections involved drug-resistant forms of HIV, and the trend was dire, with resistance increasing as high as 23 percent annually. Once individuals were put on their daily treatments, in 2017 failure rates due to drug resistance were as high as 90 percent in some countries, meaning new infections in those regions could no longer be controlled with the $75-a-year first-line therapies. The first such survey conducted in Cameroon, recently published, found that the majority of patients failing their primary treatments—up to 88 percent of them—were infected with resistant strains of HIV, and overall drug resistance rates in the West African nation in 2018 approach 18 percent.

Meanwhile, preventing HIV infection has fallen off the priority list, both in funding and individual action. A new UNAIDS-Lancet Commission report on defeating AIDS calls for an all-fronts urgent increase in prevention efforts worldwide. Rates of sexually transmitted diseases (STDs)—syphilis, gonorrhea, chlamydia, herpes, various forms of hepatitis—are skyrocketing, especially among young gay men in Europe and North America and heterosexual youth in much of sub-Saharan Africa, often in antibiotic-resistant forms. A type of essentially incurable gonorrhea—so-called XDR, or extensively drug resistant—has emerged in Australia and the United Kingdom, prompting alert across the European Union. If sexually active young adults were using condoms and following the sorts of safe sex guidelines that would protect them from HIV, these other STD trends would not be the new normal.


Laurie Garrett

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GARRETT Laurie