Thursday, March 6, 2014
[Cross posted from the Don't Get Stuck With HIV website.]
Since the early days of HIV/AIDS, finger pointing has been the main publicity angle. In Western countries the collective finger was pointed at men who have sex with men. Their reaction was to object to the finger being pointed at them and to insist that everyone is equally at risk. Though some still believe that everyone is equally at risk, it is not true. In Western countries the majority of HIV transmissions have always been among men who have sex with men, with a smaller proportion of transmissions through intravenous drug use.
But things are quite different in developing countries, particularly high HIV prevalence African countries. In high HIV prevalence countries men who have sex with men, intravenous drug users and even sex workers contribute a relatively small proportion of HIV transmissions. In fact, the largest contribution still appears to come from those with little or no risk; mainly monogamous heterosexuals. So the process of finger pointing often turns into one of victim blaming. After all, you can't point the finger at everyone around you, nor at someone who is HIV negative; so the clearest 'evidence' of unsafe sexual behavior becomes HIV positive status.
This gives rise to the task of explaining how a virus that is difficult to transmit through heterosexual sex outside of Africa is so frequently transmitted through that route in Africa. The HIV industry needed to show that 'Africans' must be promiscuous, ignorant and unhygienic. This wasn't too difficult because population control advocates (the word 'eugenics' is no longer fashionable), a significant proportion of wealthy NGOs operating in Africa, had had been playing the over-sexed, under-educated slum-dweller cards for decades.
The processes of pointing the finger at a particular group whose behavior was disapproved of, blaming those infected with HIV for their status, and concluding that HIV is all a matter of individual behavior, threw off course any efforts to reduce HIV transmission in developing countries. Although 'prevention' activities only receive a small proportion of HIV funding, that is still a massive amount of money. But prevention activities have rarely gone beyond exhortations to 'behave' in a particular way. The finger-wagging programs perfected by population control NGOs decades before HIV was identified became, and often remain, the state of the art of HIV prevention.
There has been plenty of research showing that these finger-wagging programs are of little or no benefit (except to the NGOs). An example of such research shows that "peer education programs in developing countries are moderately effective at improving behavioral outcomes, but show no significant impact on biological outcomes". There is a voluminous body of literature showing that you can't simply wag your finger at people and expect them to change their behavior, whether the aim is to address substance abuse, dangerous driving, over-eating or anything else.
Sometimes the association of HIV transmission with individual behavior is further connected with conditions that are beyond the control of the victim, for example, poverty. But this has also given rise to confusion: there is plenty of evidence that HIV in African countries is transmitted among wealthier people. This challenges the idea that HIV epidemics are driven by sexual behavior because, even if wealthy people 'can afford to have a lot of sex and a lot of partners', as the HIV industry would have it, there would need to be some poor people involved in this theory. Rich people don't pay other rich people for sex.
Instead of looking beyond sex, or sex and poverty, it seems some researchers are convinced they will eventually find out how sex and economic inequalities 'drive' HIV epidemics. One paper concludes that "Further work is needed to understand the mechanisms explaining the concentration of HIV/AIDS among wealthier individuals and urban residents in [sub-Saharan Africa]". But they don't seem to consider the possibility that their protohypothesis about sex is simply wrong. They don't seem to think that non-sexual transmission may be a very significant factor in the spread of HIV among wealthier people.
HIV can be transmitted through unsafe healthcare and other skin-piercing processes, such as various cosmetic processes. Wealthy people tend to have better access to healthcare. In fact, urban dwellers also tend to have better access to healthcare. Perhaps this is why the above paper found that HIV is "generally concentrated among wealthier men and women". This may also explain why HIV "was concentrated among the poor in urban areas but among wealthier adults in rural areas" in a number of countries.
Instead of trying so hard (and failing, over and over again) to find out what it is about the sexual behavior of wealthy people and urban dwellers, perhaps researchers should look at non-sexual risks, as well as sexual risks. Could the risks that people face be determined by their wealth and environment, precisely because they are not sexual risks, but healthcare and other risks? These risks are clearly not *individual* risks. They relate to health-seeking behavior, but it is not the behavior of wealthy and/or urban-dwelling people that gives rise to infection with HIV in a hospital or salon; the risk of infection depends on whether the facility is safe or not (which might vary considerably over time).
Some historians of HIV, such as Jacques Pepin (The Origins of Aids), admit that HIV was mainly transmitted through unsafe healthcare for many decades, and hardly ever through sexual behavior. But they don't explain how healthcare transmission magically disappeared in the 1980s even though conditions in many African countries remain very unsafe (although how unsafe they are is still a dangerously under-researched field).
Coupled with the magical disappearance of the risk of HIV transmission in under-equipped, under-staffed and badly run health facilities is the magical re-appearance of the promiscuous, ignorant and dirty African, though for many, this had never really gone away. Pepin vaguely mentions things like 'urbanization' as the main explanation for levels of promiscuity for which there has never been any evidence and which do not explain very high rates of heterosexual transmission of HIV anyway.
Ugandans have recently responded to having the finger pointed at them by allowing an 'anti-homosexuality' bill to be passed, effectively saying 'it's not us, it's them'. Various human rights groups, and even some donors, may belatedly object to such disgusting measures, which are being copied by other African countries. But the objection needs to be directed at the approach to HIV that began a long time ago, and began in Western countries, not in African countries. Men who have sex with men are by no means the only group who have been blamed for HIV epidemics. Other groups include long distance drivers, sex workers, house girls, fishermen, miners, and many others. It's this finger-pointing approach that gives rise to the stigma that those pointing the finger claim to abhor.
Thirty years into the HIV epidemic (I'm adopting the view that HIV is not a pandemic because most people don't face any risk of being infected and prevalence is, and will remain, low in most countries) research institutions, NGOs, international bodies and, perhaps most importantly, donors are still obsessing about sexual behavior and pretending that HIV status is up to the individual when it is clear that a large, but as yet unestimated, proportion of infections is a result of unsafe healthcare and other skin-piercing processes.
Monday, March 3, 2014
[Cross-posted from the Don't Get Stuck With HIV site.]
UNAIDS risk missing their target of reducing "sexual transmission of HIV by 50% by 2015". But there is a way of meeting that target, and they could meet it by tomorrow. If they belatedly admit that HIV is far more easily transmitted through unsafe healthcare, they could begin to estimate the contribution of things like reuse of needles, syringes and other equipment that comes into contact with blood and other bodily fluids.
This would also greatly assist their progress towards their 'ZeroDiscrimination' target too, because even though they can't reverse the damage they have done by insisting that Africans are irremediably promiscuous, the status of this claim as institutionalized racism will eventually become clear, at least to those who are prepared to think the issue through a little (a surprisingly small number of people so far).
After all, reducing 'sexual transmission' is one of their stated goals, whereas UNAIDS has barely breathed a word about transmission through unsafe healthcare in their 20 year, multibillion dollar, celebrity studded reign. They could just quietly (imperceptibly, even) reveal some changes in the way figures are collected and next December 1, a re-estimation of non-sexual transmission of HIV could be the subject most deserving of their customary (spontaneous) standing ovation module.
UNAIDS are uncharacteristically frank about mass male circumcision, which is something of an embarrassing fiasco: "As of December 2012, 3.2 million African men had been circumcised [...]. The cumulative number of men circumcised almost doubled in 2012, rising from 1.5 million as of December 2011. Still, it is clear that reaching the estimated target number of 20 million in 2015 will require a dramatic acceleration." (They don't say how many of the 3.2 million circumcised over quite a few years would have been circumcised anyway but took advantage of the free (anesthetized) operation.) Might this spell an unobtrusive retreat from this dangerous imperialist program?
But one of the heftiest pieces of bullshit in the 'report' (and there is stiff competition) is about "the goal of providing antiretroviral therapy to 15 million people by 2015". They say that "As of December 2012, an estimated 9.7 million people in low- and middle-income countries were receiving antiretroviral therapy, an increase of 1.6 million over 2011. That brings the world nearly two-thirds of the way towards the 2015 target of 15 million people accessing antiretroviral treatment."
The difference between UNAIDS' claim and the truth is expressed in a few words, such as 'were receiving' therapy. If they said that 9.7 million people had been recruited on to a therapy program, that might have been true (or somewhat closer to the truth). But 9.7 million is, at best, the number of people who have at one time been put on a program. Neither UNAIDS, WHO, PEPFAR, CDC nor anyone else knows how many of those 9.7 million ever took the drugs, or for how long, how many dropped out of the program, how many were recruited on to two or more programs or simply died, etc.
No one knows, and no one really cares because 9.7 million is an impressive figure, and it sounds like a good attempt at the 15 million target. There is not much incentive to estimate how many people are alive and on antiretroviral treatment, indeed, such an estimate could prove fatal to several substantial institutions (not just UNAIDS, which seems to thrive on failure to achieve anything at all, aside from spending money and institutionalizing bigotry). Is the true figure 8 million people, 7 million, or some far lower number? Billions of dollars say that no one is going to ask this impertinent question (unless they are not in receipt of any of those billions, and never will be).
Unsafe healthcare does exist in extremely poor, high HIV prevalence countries, surprising as that may seem to those who are used to the mainstream view that HIV is hardly ever transmitted through heterosexual sex in every country in the world, but almost always transmitted through heterosexual sex in a handful of African countries. What contribution does unsafe healthcare make to the worst HIV epidemics in the world, all in sub-Saharan Africa? Would it be the one or two percent UNAIDS grudgingly suggests, or something far higher? We don't know yet. No billions have been offered for the answer to this question.
Using cumulative figures is great, because you get that great 'step' effect when you produce bar graphs, and there is nothing like comforting, progressive steps to convince people that everything is good in UNAIDSland, and in the HIV industry in general. A very achievable 2015 target would be the abolition of UNAIDS and the promotion of safe healthcare. Because unsafe healthcare risks the spread of HIV, something UNAIDS has never got around to accepting. But I suspect that instead, there will be a continuation of the finger-pointing and victim-blaming that has characterized the mainstream approach to HIV in high prevalence countries so far.
Sunday, January 19, 2014
[Reposted from the Don't Get Stuck With HIV website.]
An American on her way to South Africa is said to have Tweeted "Going to Africa. Hope I don't get AIDS. Just kidding. I'm white!" This is a heartless and insensitive remark to make. But what makes it most heartless and insensitive for a white American to say it is the fact that it is so true. In the US, African Americans accounted for 44% of all new HIV infections in 2010, despite representing only 12-14% of the population. Also in the US, men who have sex with men are said to represent about 4% of the population, but account for 63% of all new HIV infections in 2010, and a disproportionate number of them are black/African American.
Even in South Africa HIV prevalence among white people is very low. But national prevalence is amongst the highest in the world and there are more HIV positive people in South Africa than in any other country. While America has the worst HIV epidemic in the developed world, with over 1.1 million HIV positive people, the majority of infections arise among men who have sex with men and (to a lesser extent) intravenous drug users. HIV infection among white heterosexuals who have no serious risks, such as receptive anal sex or intravenous drug use, is very low.
The American who tweeted the first stupid, but sadly true, remark offended so many people that she arrived in South Africa to find that a storm had erupted on Twitter and she had lost her job. So, to make matters worse, she made a statement to a South African newspaper which contained a dangerous but often heard falsehood:
"For being insensitive to this crisis -- which does not discriminate by race, gender or sexual orientation, but which terrifies us all uniformly -- and to the millions of people living with the virus, I am ashamed."
This is completely untrue, as the figures for the US show so clearly. About two thirds of people living with HIV globally are black Africans. An estimated 60% of HIV positive people in Africa are female, compared to only 20% of new infections in the US in 2010. Hispanics and Latinos in the US made up 21% of new infections in 2010; the rate of infection was 2.9 times higher in Latinos than it was in white males; it was also 4.2 times higher in Latinas than in white women.
HIV most definitely does discriminate by race, gender and sexual orientation. This is not a new discovery, either. It may be an acceptable thing to say in certain circles, but we should never forget the differences between HIV in Africa, where the majority of HIV positive people live, and HIV in developed countries, where HIV is less prevalent overall, and is rare among heterosexuals who have no serious risk behaviors.
Justine Sacco, who tweeted the remark, is so right to think that she is very unlikely to be infected with HIV; a lot less likely than a black African, and also less likely than a black or Latino/Latina American. It is disturbing to think that so many people continue to believe or say otherwise. Why is HIV prevalence so high among black Africans and black/African Americans, yet comparatively low among white people, especially white men who engage in no serious risk behaviors?
Sunday, November 17, 2013
[Reposted from the Pre-Exposure Prophylaxis (PrEP) Blog]
After years of trying to create a market for pre-exposure prophylaxis (PrEP) pills, such as Truvada, Big Pharma has turned to their favorite mass marketing ploy: dumping their products in African countries that are starved of health funding. Of course, why wouldn't they dump them in Africa, won't they be paid for with donor funding?
An article in Kenya's The Star entitled "Kenya: 'Wonder Pill' for Risky Sex On the Way" takes the unusual step of raising some difficult questions about PrEP, rather than repeating the Big Pharma press release, despite a shaky introduction. The article continues "Kenyans involved in risky sex behaviours will soon get a 'wonder pill' that can prevent HIV infections. Experts say Truvada, which some call the 'new condom', can reduce chances of catching HIV but there are fears the drug may be misused by the youth".
What, exactly, would constitute misuse of the drug? If it can cut the risk of infection by "up to 75 per cent if one faithfully swallows it daily", what could go wrong? Well, as the article eventually reveals, most people don't swallow drugs daily and most people can not expect 'up to 75%' reduction in risk. That figure is not even from a randomized controlled trial, but from a 'sub-group' study, where the best results are used to exaggerate the level of protection people, in (comparatively) strict trial conditions, may expect. Outside of that sub-group, and outside of drug trial conditions, risk reduction is far lower.
It's odd that such reports talk about studies and proofs for something that they then refer to as a 'wonder pill', a 'new condom' and talk of 'up to 75% protection' (although that's a bit weak compared to the term 'invisible condom' used by those marketing mass male circumcision), and the like. These are PR buzzwords, not scientific findings.
It is said that PrEP programs intend identifying those most at risk of being infected, such as sex workers, intravenous drug users and men who have sex with men. This will be a departure from vilifying these already stigmatized and criminalized groups; it remains to be seen how much donor funding will actually be spent on these groups to provide them with PrEP, given that it has been so difficult in the past to provide them with condoms, injecting equipment and even basic sex and sexuality education.
As the article says, Truvada is expensive, and it has made billions of dollars for Gilead. So it's worth their while pushing as much of the stuff as possible in countries with high HIV prevalence while the patent guarantees that their product will face little competition. By the time the patent expires the likes of Bills Clinton and Gates will surely have set up some program whereby the drugs can continue to be purchased at inflated prices.
The article makes the important point that nearly 1 million HIV positive Kenyans currently need antiroviral drugs just to keep them alive. So why would donors want to provide these same drugs to people who are not yet infected with HIV (aside from an obvious desire to enrich big pharma)?
Oddly enough, a cost effectiveness study makes its estimates using existing levels of male circumcision and antiretroviral therapy. This means that the three multi-billion dollar programs will be in direct competition with each other for funding, and each one will be trying to claim that any drop in HIV incidence is a result of their work. The study also seems to assume far higher levels of success than have been achieved so far. But that's big pharma for you.
While Gilead and other pharmaceuticals can gain a lot from any increase in antiretroviral therapy and PrEP programs, they may not stand to gain from mass male circumcision programs. Their assumption that their PrEP programs will be cost effective only in countries where circumcision levels are low suggests that by the time their product may be approved, the circumcision programs will already need to have failed, some time around 2015.
Worries that people may use PrEP as a kind of recreational drug, so they can dispense with the use of condoms when they are engaging in sex with people who may face a high risk of being HIV positive are not very convincingly addressed; nor are worries that overuse and misuse of antiretrovirals, either for HIV positive people or as PrEP, are brushed aside, with remarks about "government policy" and making the drug available "in form of a package that probably includes HIV testing and other prevention methods".
I seem to remember condoms, circumcision, ABC and various other programs being made available in the form of a package, without that leading to extraordinary results. But it will be interesting to see if PrEP will erode some of the funding currently being made available to, or earmarked for, mass male circumcision programs.
Circumcision programs stand to rake in billions for the big providers, but widespread use of PrEP would be worth far more. It's unlikely that a full scale version of both programs could co-exist; they are not mutually exclusive, but their cost effectiveness is predicated on their being the only or the main program in high HIV prevalence countries.
Whether one program displaces another, or whether they all get funded, the losers will be people in high HIV prevalence African countries, which will continue to suffer from under-funded health and education sectors. They will continue to be a mere 'territory' for sales reps, who will continue to carve things up in ways that should be very familiar to us by now.
Sunday, November 10, 2013
Internews describes itself as an "international non-profit organization whose mission is to empower local media worldwide to give people the news and information they need, the ability to connect and the means to make their voices heard". But one of their much trumpeted programs claims to train journalists about the 'science' behind mass male circumcision programs in Kenya and creating demand for the procedure. There's quite a difference between training journalists on the 'science' of circumcision and creating demand, and the latter generally has little to do with empowerment.
The fact that the BBC's Media Action portal, Creating Demand for Voluntary Male Medical Circumcision, which is backed by the Bill and Melinda Gates Foundation, has named the work of Internews as an example of best practice also says a lot more about the three institutions' shared biases than about empowerment. Even the URL bluntly states the bias.
A press release gushes: "Internews’ training approach illustrates the benefits of training journalists to report accurately and impartially on culturally sensitive topics, such as VMMC. The training resulted in some 100 news stories focused on this high impact HIV prevention procedure that were published or broadcast. What was notable was that the media did not carry any negative news stories about the topic during the period that Kenya was rolling out the medical procedure in Nyanza Province." Oddly, another version of this press release uses the term "falsely negative news stories"; I wonder which is correct? Or is any negative news story 'falsely negative'?
So where is the impartiality in creating demand for mass male circumcision? If people have reservations about circumcision perhaps they have good reasons to. But if the procedure is as wonderful as proponents claim it is, why should such aggressive demand creation be necessary? It is claimed that Internews training "does not prescribe to journalists what to cover" but that their main concern is accuracy. Yet their country director Ida Jooste, perhaps inadvertently, flatly contradicts this claim.
She says that a "critical article was published in Uganda about VMMC quoting a poor-quality study which attacked the credibility" of the often cited Randomised Controlled Trials that took place in Kenya, Uganda and South Africa. Without citing that 'poor-quality' study, she goes on: "Rather than wait for the Kenyan media to pick up and run the story, Internews proactively convened a round-table with journalists and VMMC experts from the National AIDS and STI Control Program, and other organizations to analyze the story and examine its scientific arguments. As a result, not a single media outlet in Kenya chose to pick up or run the sensational story."
I don't think I'd use the word 'impartial' there. Ensuring that only positive coverage is aired and that negative coverage is quashed is media censorship and control, pure and simple. This is all paid for by the US taxpayer, though it seems the UK may now have something to do with it too.
Internews also 'worked with' (should that be 'worked on'?) civil society and health agencies working in the field of mass male circumcision. When they ran a conference focusing on women's 'involvement' in mass male circumcision, "to their delight" this resulted in 25 news and feature stories. This is pure manipulation, but those involved seem to express no shame, apology or even justification for it. Joost is even cited as saying "We believe that the impact of positive media coverage, or at the very least, the absence of negative coverage, complements and reinforces traditional public campaigns aimed at creating demand and behaviour change".
The above illustrates a concerted effort by a donor (Gates), an international media outlet (the BBC, via its corporate social responsibility wing) and a well-funded US non-profit, to control the Kenyan media. These parties then openly report their successful manipulation and censorship of the media, which has resulted in completely biased coverage of a public health program that is opposed by many of those who have taken the time to inform themselves about it.
What kind of foreign donor funded public health program, only carried out on certain African populations, is so important that it is necessary to manipulate the press so that they only report positive stories and that they don't report negative stories about it? If Kenyan people had any objections to this kind of neo-imperialism, would their press even report it? If the US wanted to impose a mass male circumcision program in the UK, would the BBC also collude with Gates, PEPFAR, CDC, UNAIDS and other parties to make sure objections were not heard? This must be what is meant by 'informed consent'.
Monday, November 4, 2013
BuzzFeed has photos of 10 signs photographed in South Africa during the apartheid era and it is truly shocking to think that, as the article points out, these signs only became illegal in 1994. But that's why it should be even more shocking that instances of extreme racism and apartheid style thinking should still be so common in the international media today. I have listed a number of examples below, with links to some of the most offensive articles I've read in the past few years.
These are just the tip of the iceberg and a full study would take years. But, in no particular order, let's start with the stories about condom 'recycling' in Kenya and condom 'rental' in Tanzania. Whether the journalists who wrote these stories were bored or desperate is just one question; but what about the media outlet that published them and the public who read them?
One that goes back a few years is the 'story' about starving HIV positive people on antiretroviral drugs eating cow dung in Swaziland. Numerous media outlets echoed that one and it cropped up several times. There was even a story about a woman in Namibia who claimed to have eaten cow dung but then admitted that she had made it up. She didn't attract anywhere near as much publicity, though.
The ever-popular notion of 'African' sexuality is a trusty tool in the journalist's store of prejudices. Although it has been debunked many times, the media picture of Africans has remained faithful to their apartheid agenda. Africans are truly 'other', that's why there are such massive HIV epidemics in some African countries, isn't it?
The UNAIDS Modes of Transmission analysis, which produces the 'science' behind the media's HIV related racism has also been criticized, but why attack the source of so many stories that everyone seems to enjoy and find so completely inoffensive? UNAIDS even recognizes the true HIV danger in African countries, unsafe healthcare. But they keep that to themselves, publishing advice about avoiding non-UN approved health facilities in a booklet for UN employees, courtesy of the sweetly named 'UN Cares' (about its own employees).
Occasionally a journalist may allude to the use of African participants as research fodder, but people are too used to hearing about the oversexed and feckless African to care very much about such abuse, especially when it can always be dressed up as 'helping'.
It's coming up to about six years since the international media 'discovered' the Tanzanian albino attacks and killings, even though they had been reported in local media for some time. The sloppy and offensive coverage that followed this great 'scoop' for the BBC continues, as do the attacks on persons with albinism. Why revise a story that has won praise and awards? Of what importance are accuracy and insight when opportunities for self-adulation are at stake?
The disgusting US Christian right story of the use of adult pampers as a result of anal sex among men who have sex with men has even done the rounds in some of the local media. We see articles about African countries claiming that homosexuality is 'brought in' by foreigners. But where did the homophobia come from?
There are sometimes instances of the kind of media friendly racism that is 'roundly' condemned, trivial matters that keep readers entertained, much easier to write about than anything that matters. But what the media writes is clearly not yet a source of offence to most people. Perhaps in years to come sites will be able to list some of the shockingly abusive things the mainstream media published about African people, who knows?
Wednesday, October 16, 2013
[Crossposted from Blogtivist; the link provided to the UN report was to a different report and the correct link has now been provided, apologies for any confusion this may have caused]
This open letter to you is about one of your recent reports, entitled 'Persons with albinism' (A/HRC/24/57), dated 12 September 2013. Your summary gets to the point: "In some communities, erroneous beliefs and myths influenced by superstition put the security and life of persons with albinism at risk." You also refer to 'ritual' killings and attacks to which many persons with albinism have been subjected over the last six or seven years, particularly in Tanzania. You remark that "[t]he information on the various cases collected by OHCHR came from multiple sources, but the level of verification varies in each case.
It is this level of verification that especially interests me. Earlier in the report you stated that "[t]he collection and verification of cases of ritual attacks is a challenge due to the secret nature of witchcraft rituals, the inability and/or fear of victims’ relatives to report such incidents...[etc]." I would suggest that, from the earliest killing reported in the international media, widely believed to emanate from the BBC, all witchdoctors and other people reputed to be engaged in witchcraft, or related activities (very different sorts of activity among which the BBC makes no useful distinction), have been thus implicated in the attacks.
I hardly need to remind you what that means. Many people, in Tanzania and other countries, have been persecuted by mobs, even lynched, because of the belief that they were engaged in witchcraft or something similar. Indeed, what may have been the first 'ritual' killing of a person with albinism, reported in the Legal and Human Rights Center in their 2006 report, is a brief mention of two men who were lynched by a mob; the brief mention is, essentially, about the killers themselves, not their victim. Your report does not mention the Tanzanian Witchcraft Ordinance of 1928, which proscribes public accusations of witchcraft without providing evidence that the accused actually practiced witchcraft or claimed to possess witchcraft powers, etc, but I’m sure you are acutely aware of the risks that those merely suspected of witchcraft, and even those investigating attacks on persons with albinism, face.
I needn't labor the point; witchdoctors have very good reason to be secretive, especially when everyone points the finger at them following the (rether frequent) occasions on which the media sees fit to implicate them. I'm sure you haven't forgotten earlier stories about the 'skin trade' in Tanzania, 'devil worship' in Kenya and various other phenomena more notable for the vast number of column inches dedicated to them that to the substantive content of the various reports that came to be written about them.
Your report notes that victims, their relatives and fellow community members are afraid to report killings. But it's only natural to fear those who are thought to have magical powers, and worse, to be so ruthless that they would attack people with machetes to maim and/or kill them, or even to instigate such a killing. However, could people actually be more afraid of the absolute demons they read about in the press than anything they have ever experienced? Could they be afraid of something they have never seen, but which they are assured by everyone who has read these reports, exists among them and wields a terrible power over them?
As you say, levels of verification are important. The vast quantity of media coverage may one day yield up something that constitutes evidence of such devotion to superstitions that it leads to maimings and killings; the small handful of sources of information on which the media depends, and on which your preliminary report now depends, may have some checkable, some verifiable source of information that lies, however hidden, behind it. Perhaps this could be used to carry out an investigation into some of the killings, at least the ones for which there is even a minimum level of documentation.
But I would suggest that the media itself has often been secretive, a bit ritualistic, even a bit fetishistic, at times. They constantly refer to things as if they have evidence, words like 'official' are used (although few journalists, if any, seem to view the police, or any other commonly used informants in such cases, as a possible source of anything except further unsubstantiated information, ridicule, stories about corruption, predictable stuff), they write as if the very dogs on the streets know that all these attacks were carried out by witchdoctors who paid 'middlemen' to 'obtain' body parts of people with albinism, for which 'rich and powerful' people pay large amounts of money to ensure that they become more rich and powerful.
It's a very credible story, in a sense, given the many other incredible stories we are told about Africans or, in this case, Tanzanians; a story of superstition, poverty, bullying by rich people, incompetence by 'officials'. But it's a story for which the media provide little or no evidence. Tanzanian people may well have been convinced that witchdoctors are rich and powerful, and that they themselves could become rich and powerful by working for them, or for their rich and powerful clients. But, aside from the plentiful supply of gossip, where is the evidence? Or should I ask what constitutes evidence in these cases? If the sheer number of media reports constituted evidence, all Tanzanian witchdoctors (and those thought to be witchdoctors) would be locked up, perhaps even condemned to death. But none, as far as I know, have been executed (unless some have been killed by mobs). Few have even been through the courts.
I truly hope any evidence that exists that sheds light on these attacks on people with albinism is going to be handed over to you by those who have generated so many media reports based on what seems to them to be so certain. Your preliminary report suggests that little new evidence, with a reasonable level of verification, has yet been made available to you. It is to be hoped that all will be revealed in the final report, after a thorough investigation, one that looks critically at the assumptions we have been making for around seven years without putting a stop to the attacks, apprehending the attackers, or protecting the victims and those around them.
As things stand right now, perhaps there is something wrong with our assumptions? The practice of 'witchcraft' was banned without that preventing further attacks. Over 170 people were allegedly arrested, and let go (at least, I hope they were let go). Apparently over 70 of them said they had been told by witchdoctors to bring them albino body parts. Could this be an important lead? Or could it suggest that everyone reads what has been written in all the papers for months, or talks to someone who does? None of these people were convicted. That could be because there was no evidence, aside from the fact that they were witchdoctors, suspected of being witchdoctors, associated with witchdoctors, etc.
Or maybe they were not involved, or not even completely aware of what was going on, aside from what they read in newspapers or heard from people who read them, or claimed to? The media calculated and recalculated the figures for victims and deaths: there were 4 in December 2007 but 20 by January 2008, without any media report that I could find accounting for any of these new attacks by providing basic details; who were all these victims? Generally we don’t even know their names, sometimes not even their gender. Was their body discovered somewhere, or was there even a body? You may think these are silly questions, because the media eventually agreed by some time around 2012 that there were over 70 deaths. But how starkly all this contrasts with reporting on murders in Western countries, where some of them become household names; at least we get the basic details.
At first, it was claimed there were 71 deaths if you included 17 from Burundi, seven from Kenya and three from Swaziland, but it is asserted that there were 71 deaths in Tanzania by the end of 2012, without that qualification, and by 2013 the BBC raised that to 72 deaths in Tanzania. I suggest that the running tally of deaths has become a bit confused and that various reports are mixing up important details. Perhaps all I am lacking is access to ‘official’ sources, to which some refer, but if there are official sources I believe they should be named, or at least described. Otherwise we don’t know if this is an instance of secrecy, sloppiness or exaggeration.
According to the media accounts that I have looked at there were well over 30 deaths that attracted enough media interest for something about the incident to be recorded, the age, location or some circumstance, such as 'skinning' of the victim. There were well over 70 documented attacks. Not over 70 killings, as the media eventually agreed, but as I said, they could be keeping their cards close to their chest. But attacks continue. Media coverage has waned considerably since 2008 and 2009, but I have tried to account for documented victims in the linked table and I would welcome additions to it.
You will, no doubt, have read a lot already, possibly coming across odd recurrences and even more odd contradictions, even convenient, but unsubstantiated juxtapositions. You will probably even notice that predictions, such as the fear that lots of persons with albinism would be maimed and killed before the 2010 Tanzanian elections turned out to be unfounded? It doesn't say that in the mainstream media, as far as I know, but nor could I find any articles about a noticeable uptick in attacks. Documented victims peaked in 2008, but again in 2011. There was a big dip in 2009 (without a corresponding dip in media coverage), with a further dip in 2010, by which time media coverage began an exponential decline that has continued for several years. I quite accept, of course, that my data is limited to what is available, free of charge, online; the media may have access to other information to which I am not privy, but to which, I hope, you are privy.
To conclude: you mention 'erroneous beliefs and myths, heavily influenced by superstition' in your analysis of attacks on persons with albinism. I would add to that a set of erroneous beliefs and myths that are heavily influenced, even promoted, by the media. If people believe in the great power of witchdoctors, and believe that they can get paid a lot of money to carry out a maiming or a murder, they are quite wrong, and it behooves the media to make that completely clear, now. But why would ordinary Tanzanians even believe such a thing? Perhaps they deserve to be condemned for being stupid enough to commit a terrible crime on the stuff of rumor and gossip. But ordinary Tanzanians themselves are not the source of all rumor and gossip, nor are they the sole spreaders of rumor and gossip.
If it is the case that not all witchdoctors are so powerful and so ruthless, that not all 'middlemen' (and what ordinary Tanzanian could not, going by media descriptions, fill that role?) are so greedy or so gullible, even that most ordinary Tanzanians living in rural communities (and we are frequently told about levels of superstition in rural areas) are not so cowardly or so despicable as to turn a blind eye, or to conspire with other parties, as to maim and kill members of their own community or their own family 'because of their superstition', or worse, because of lust for money, then the entire investigation of the attacks needs to begin again.
Why? Because the received view of these attacks needs to be called into question. We simply don’t know much for sure about witchcraft, a ‘trade’ in body parts, or a ‘rich elite’ that is willing to pay large sums of money for goods and services provided by witchdoctors; we don't know who we are looking for, what they are like, how many they are, aside from the suggestions provided by the media.
I believe it is vital for us to understand the root causes of attacks and discrimination, and your report refers to these among your recommendations. However, the distinction between the causes of the attacks and the causes of the discrimination is just as vital. The attacks are a relatively new phenomenon, even various media cited sources agree on that. But the discrimination goes back decades, perhaps centuries, and affects the millions of disabled people living just in Tanzania alone (an estimated 2% of the population), to this day, not just the tens of thousands of persons with albinism (or hundreds of thousands, depending on which article you read).
Media reports, and other reports depending on media reports, do not constitute a solid foundation on which to base further investigations. I am sure you are aware of that, but what I have read so far, in the media and in other reports, is highly questionable. Yet I see virtually the same material in your preliminary report. It is not my intention to advise you, only to urge you that the current body of data on attacks on people with albinism may not yet be very reliable.
I look forward to a report that results in the protection of persons with albinism, brings perpetrators of violence to justice and ensures that these attacks never happen again. Following the publication of the report, persons with albinism, those associated with them, those associated with attacks on them, and all other innocent people, will enjoy those human rights that have, up to now, been denied them.
In addition to compiling a web page of documented attacks, to which I have provided a link, I have various other data that I have collected. If I can be of any assistance to you or your officers, please do not hesitate to get in touch with me.