Time To Rethink HIV and AIDS Spending

Back in March last year, in an article entitled "Aids to lose ‘special status’ in new plan", Dr Martin Sirengo of Kenya's National Aids Control Program said “HIV is no longer a big issue. It is just like any other disease because we now have the knowledge about it, we have the drugs, and nearly everybody knows about it”. Sirengo is perhaps exaggerating but more than 90% of Kenyans are not HIV positive and many suffer from diseases that could have been prevented or could be treated, if the government (and foreign donors) saw this as important enough.

Sirengo goes on to say that Kenya "is in the process of implementing a disease integration model that will eventually do away with emergency response to HIV/Aids and address it like any other chronic disease." Apparently the program was already underway then and was due to be fully implemented by 2012, resulting in the "demise of special rooms set aside for voluntary counselling and testing at health centres or even special pharmacies for HIV cases".

It's hard to know whether this 'integration' was driven by a desire to spend less money on HIV or if it was seen as a way to spread health funding beyond facilities that deal with HIV and pretty much nothing else. After all, HIV positive and HIV negative people alike suffer from and die from all sorts of conditions. But Sirengo says "These may be the first steps that could eventually lead to the dismantling of parallel, but expensive administrative structures set up to manage the pandemic."

At the time, Sirengo's comments were expected to meet with a lot of opposition from NGOs, government agencies and other parties benefiting from funding specifically for AIDS. He pointed out that specialist skills would still be needed, and that the approach was being gradually rolled out already. But sure enough, a whole group of institutions concerned with HIV and AIDS got together to protest.

It's worth looking carefully at the letter this group wrote, outlining why they see the proposed approach to HIV and AIDS as so objectionable and arguing that HIV is still an emergency. The letter is addressed to the Ministers for Public Health and Sanitation, for Medical Services and for Special Programs. It is pointed out how many people are estimated to be living with HIV, how many need treatment, how many receive treatment, numbers of new infections per year, deaths from AIDS, children born with HIV, etc.

The figures are frightening, but they don't immediately add up to an argument that the country, already starved of public sector spending on health for several decades, should spend so much money on parallel systems for one disease. The letter does not make it clear why testing people for HIV in one place and testing them for all or most other disease somewhere else is a good way of ensuring high levels of public health.

Rather, the big gap between what is required and what is available suggests a more urgent need than ever to use every shilling wisely. If a health facility can test for HIV, why should the same facility not also be able to test for other far more common diseases, including non-communicable diseases?

The letter mentions issues of stigma and discrimination, as if having parallel systems for a disease said to be between 80 and 90% heterosexually transmitted could in any way reduce these; on the contrary, separating HIV from other health issues is far more likely to fuel stigmatizing attitudes and discriminatory behavior. In fact, given that it is unlikely such a massive proportion of the disease really is spread sexually, treating HIV as different from all other diseases is a form of discrimination. People found to be HIV positive are effectively branded as being promiscuous.

However, the group is not opposed to some kind of integration. Rather than opposing the approach at all costs, they seem to interpret Dr Sirengo as using it as a smokescreen to reduce overall spending or as an excuse for continued underspending on health. They are right, sadly, in their claim that health is underfunded. But while HIV may not be overfunded, there appear to be a disproportionate number of institutions and facilities dedicated almost entirely to the virus when the majority of sick and dying people do not have HIV.

Anyhow, all this was before the Global Fund decided that it would be suspending disbursements for the next two years. And now, Dr Sirengo's comments have appeared yet again, this time in an article that says both donors and the government agree that 'downgrading' HIV's 'emergency status' is the way to go. It had been suggested that the Dr's remarks were his own and not representing those of the National Aids Control Program or the government; but even the Public Health and Sanitation Minister, Beth Mugo, is cited as being in agreement: "Integration is the way to go because it makes logistical and economic sense".

If there are about 110,000 new infections every year, and about 90,000 deaths, the costs of treatment and care will continue to rise. But one of the best ways of ensuring that the numbers of new infections go down is to identify who is at risk, what risks they face and what strategies most effectively reduce the risk. It will be painful for many groups working in the HIV and AIDS field to face up to the fact that it's not all about sex, but concentrating almost entirely on sexual transmission has failed; it's a good time to admit to being wrong.

Health facilities need to be safe places, where people don't pick up something worse than they had when they arrived, such as hepatitis or HIV. It would be inhumane to ignore the plight of those who are living with HIV; but it would be insane to continue to leave non-sexually transmitted HIV uninvestigated. And Dr Sirengo is wrong in one crucial respect; almost everyone does not know about non-sexually transmited HIV. If people don't know about non-sexually transmitted HIV, they will not recognize non-sexual risks and will no know how to avoid them.

[For more about non-sexual risks for HIV transmission, see the Don't Get Stuck With HIV site and blog.]

Depo Provera: English Guardian Aligns Itself With Neo-Eugenicist Policies

The English Guardian may face something of a dilemma when covering the WHO's failure to give clear advice to African women who have been persuaded to use Depo Provera and similar injectable hormonal contraceptives, which appear to be associated with a doubling of HIV transmission from females to males and from males to females; birth control is close to the heart of he who would control population, Bill Gates, whose Foundation sponsors the paper's Global Development section. Not that the article appears in the Gates sponsored section; perhaps there is no such dilemma.

But Sarah Boseley sticks pretty close to the WHO's press release and says that women who use injectables such as Depo Provera should also use condoms. As with the 'advice' from WHO, Boseley notes the use of 'dual protection' against pregnancy, on the one hand, and infection with sexually transmitted infections on the other. For Boseley and WHO, this means using condoms along with Depo Provera. But what neither seem willing to point out is that condoms on their own provide such dual protection.

So why would anyone want to use these expensive and possibly dangerous hormonal injections if condoms on their own give dual protection? Well, according to WHO and other 'experts' in reproductive health (often just a useful term for 'birth control'), condoms are not 'female controlled'; many people don't use condoms if they can help it. So rather than recommending that people who wish to avoid both pregnancy and sexually transmitted infections should use condoms, they recommend that people use Depo Provera, despite knowing that many people who opt for injectable hormonal contraceptives (and various other methods) cease to use condoms?

The oral versions of Depo Provera and similar contraceptives are said to be unsuitable because women need to take them daily and they may forget, or their husbands may object, etc. Injectable versions are said to be women controlled and only need to be taken every three months. In reality, they are to a large extent controlled by those who supply them, often NGOs and other institutions who believe strongly in the population control paradigm of development. Whatever synonyms are used, the concept of control is always detectable.

Boseley claims that women 'choose' Depo Provera and similar products but these pharmaceuticals are aggressively marketed by some of the biggest NGOs working in population control. Use of injectables has increased considerably over recent years but it's difficult to work out whether that's a matter of availability or genuine choice. Given the political and financial clout that NGOs and institutions such as the Gates Foundation have over the lives of people in developing countries, it seems unlikely that birth control is as high on the agenda of people in African countries as it is for the various non-African parties on the bandwaggon. One might even wonder if anyone gives a damn what Africans think about such matters.

It's astonishing just how uncritical Boseley is, in fact. She parrots bits about the WHO's 'expert group', but it was not concluded that hormonal contraception is safe ("Current evidence is not strong enough to prove or disprove an increased risk of HIV from hormonal contraception"). Rather, it has clearly been decided that it is safe enough for Africans and other poor people; it is not much used by white, middle-class Westerners. These products have not been shown to be safe, far from it. But the most important consideration for the WHO is that their goal of population control is not compromised by worries about safety issues, which they have been aware of for decades.

The logical conclusion to be drawn from the WHO's findings is that, if people want to avoid unplanned pregnancy and sexually transmitted infections, they should use condoms. The WHO statement is not based on a logical conclusion; it is a political declaration designed to protect the interests of Big Pharma, big NGOs and big private institutions with a population reduction agenda, and of course, the interests of the WHO itself. As for UNAIDS, they have taken a back seat; HIV prevention has never been their strong point.

Boseley finishes with a few non sequiturs and then supplies a version of the population control enthusiasts' mantra: "About 25% of the 128 million married or cohabiting women in sub-Saharan Africa aged 15 to 49 want but cannot obtain contraception." This self-serving statement doesn't tell us who was asked the questions, who was asking them, what questions were being asked and who chose those questions; a far higher percentage of women (and men and children) face numerous life-threatening issues on a day to day basis. It is likely that some of those issues would carry a higher priority, such as lack of clean water and sanitation, accessible and secure food supply, adequate living conditions, and many others.

When you know how you will get through the next few years, you can plan the next few decades. Family planning is not the panacea depicted by WHO when you are faced with low survival rates for your children and life expectancy for yourself. Population control in the form of birth control and family planning can be dressed up to look like an obvious choice for people in developing countries. But large scale population control exercises are not, neither in intention nor in practice, matters of choice for their putative beneficiaries. Population control is the prerogative of those who also control vital resources and the like, and who wish to limit access to these for people who are at the bottom of the heap.

Consider the role of eugenicist and neo-eugenicist doctrine in developing countries over a period of many decades; population has risen rapidly, regardless. Far from people being given choices over matters such as family planning, self-determination has been systematically denied. But Western maneuverings have failed to control population growth; they have only brought developing countries to their knees, creating new problems and exacerbating existing ones. When the rich and powerful talk piously about choice, it's always worth remembering that they consider their choice to be the only viable one.

WHO Refuses to Give Correct Information About Depo Provera

The WHO has issued a statement stating that the injectable and oral versions of hormonal contraceptives, such as Depo Provera, are safe for HIV positive people and those thought to be at risk of being infected with HIV. This is an odd statement to make when they have known for a long time that this form of birth control has been associated with double the risk of transmission from HIV positive women to HIV negative men and double the risk of transmission from HIV positive men to HIV negative women, where the woman is using hormonal contraceptives for birth control.

The HIV industry, and the population control obsessed development industry before them, have always placed controlling the reproductive behavior of people in developing countries above their reproductive rights and safety. Regarding Depo Provera and similar hormonal contraceptives, fatuous arguments about reducing 'unplanned' pregnancies, reducing reproductive health problems and HIV transmission have been used when the very method itself places those using it and their partners at increased risk of being infected with HIV and other sexually transmitted infections.

WHO did not make their decision on the basis of a "thorough review of evidence about links between hormonal contraceptive use and HIV acquisition"; they held their 'high-level' meeting in private and compelled all those attending to sign a confidentiality agreement, a gagging order. The thorough review would have taken, by their own admission elsewhere, several years to complete. Why the secrecy? Why the deceit? Who has an interest in putting the health and lives of millions of adults and children in Africa at risk? Is this a commercial decision, a political one, a combination or something far more sinister?

Reminiscent of the 'advice' given to African men who have been duped into being circumcised, ostensibly to reduce the probability of being infected with HIV (even though they may be far more likely to transmit the virus as a result), the WHO statement reminds people that Depo Provera and similar need to be used with condoms. However, we know condoms work; why not just use condoms, or perhaps condoms in conjunction with a method that is not harmful? If condoms don't work, why advise the use of a hormonal contraceptive that very likely increases transmission in both directions (or an operation that does little good and a lot of harm?)? We know that Depo Provera use is associated with reduce condom use, but condoms prevent conception and the transmission of sexually transmitted infections, such as HIV and many others.

What is the point of WHO now that they have shown that they do not represent the interests of ordinary women, particularly poor women; the vast majority of Depo Provera users are in sub-Saharan Africa? What about all the NGOs who have creamed off the billions of dollars of HIV money over the last thirty years to promulgate their eugenic policies? Because eugenic is what they are; if you're poor, have fewer children. People need advice, support and information, accurate, reliable information. Otherwise NGOs, WHO, UNAIDS (see UNAIDS' statement on Depo Provera) and the like are pursuing their own agenda, regardless of the interests of those they purport to serve.

Through the administrative fog generated by these grotesquely overfunded institutions, little is clear about Depo Provera except that the above institutions can not be trusted. If you want to advice, you'll have to carry out your own research, but start somewhere else; the very bodies tasked with informing people have failed, indeed, have refused to publicly discuss the information that is available to them. Judge their statements by that failure and refusal. There has never been a better time for African countries to distance themselves from those who see Africans as mere instruments in the agenda of money-making and empire building.

[There are links to some more reliable information on injectable contraception on the Don't Get Stuck With HIV website and blog. More will be made available in the coming days.]

Much Needed Attention for Healthcare HIV Transmission, But Little for Patients

A married Kenyan couple decided to get tested for HIV after the woman became sick and it was found that she was positive but her husband was not. This is not particularly uncommon, but it is shocking that there is no mention in the article about the possibility that the woman was infected non-sexually. The husband considered leaving her, but it appears the counselor didn't tell them that HIV is not always transmitted sexually and that, whatever risks the woman faced, the husband and millions of other people also face.

Incidents like this can put the female partner especially in a lot of danger. Some have been thrown out of their home, either by their husband or other relatives, lost their children, possessions, job and much else. Some have been subjected to violence and even have died as a result. It is extraordinary that the counsellor's job appears to be merely to urge the couple to stay together, but not to recommend that the risks, both sexual and non-sexual, faced by the HIV positive person be evaluated and, if necessary, investigated.

The majority of Kenyans have probably never been tested for HIV and many more keep the results to themselves. But that's hardly surprising if people can face such threats just for revealing their status, even if they do so in order to avoid infecting others. It would be far preferable if more people knew their status and they were supported to reveal their status, at least to their sexual partner; in that way, their risks could be identified and many future infections could be prevented. But as long as UNAIDS and the rest of the HIV industry refuse to discuss the non-sexual risks people face, many people in a country like Kenya are at serious risk, regardless of their sexual behavior.

This situation tends to hit women harder than men; women are often expected to test for HIV, before, during or after pregnancy, sometimes on several occasions. It is more difficult for them to hide their status from others, although testing is ostensibly voluntary and confidential. Women are more likely, often a lot more likely, to be infected than men. And they do not generally have the authority in a marriage to insist that their partner is tested, or to receive a fair hearing if their partner is not infected.

The kind of irresponsible nonsense people hear about HIV and sex is epitomized in numerous articles, including one about "Tips for Making HIV Discordancy Work". There is no warning about non-sexually transmitted HIV or about the fact that the infected partner may not have been infected sexually. The article even recommends keeping antiretrovirals handy in the form of Pre-Exposure Prophylaxis (PEP), used when someone may have been exposed to HIV, through sexual or blood contact, for example. But those who keep PEP handy won't know when they need to use it if they have only heard of sexually transmitted HIV.

It seems unlikely that the HIV industry obsession with sex and their reluctance to talk about non-sexual exposure are going to disappear any time soon. But the Minister for Medical Services, Anyang' Nyong'o, who has touched on the subject before, has announced that Kenya will be opening up a Center for Training on Blood Safety. It sounds like the thrust of the training given will be to protect health care personnel from infection, but it may include training on unsafe use of medical equipment, which poses far higher risks to patients than it does to employees. Anyhow, the proposed Centre for Excellence in Phlebotomy and Specimen Collection, sponsored by medical equipment manufacturer Becton, Dickinson and Company, is a start.

Aside from the estimated 2.5% of HIV caused by medical equipment, which is likely to be on the low side, the article also cites 'rampant' misdiagnosis by health personnel, lack of training and poor practices. These phenomena are well attested in documents such as the Kenya Service Provision Assessment, but are rarely alluded to in the burgeoning HIV literature. Let's hope this facility proves to be a lot more than "a milestone towards the improvement of health-worker safety"; very few health workers have been infected with HIV through their work but many patients may have been exposed to HIV and other diseases through unsafe health care. Sexual transmission of HIV is only part of the story; we just don't know how big a part non-sexual transmission is.

[For more about non-sexually transmitted HIV, see the Don't Get Stuck With HIV website and blog.]

Collecting Data Only to Explain it Away

The HIV industry loves the story of massive increases in 'unsafe' sexual behavior as an explanation for rapid increases in HIV prevalence in high and medium prevalence countries. If the author can even be bothered to say why unsafe sexual behavior should have increased at some period, they vaguely point to urbanization (which started long before HIV spread from its epicenter and continues in most high prevalence countries thirty years later) or some such phenomenon. As for the decrease, it is rarely mentioned, unless it is to say that it was a result of various policies, strategies and activities, with which the HIV industry of the day was fully engaged.

The story must assume or even include subsequent and equally massive decreases in unsafe sexual behavior when prevalence rapidly drops later. The problem is, the drop in prevalence is more likely to be a result of very high death rates, which tend to occur some years after the epidemic began. As for these increases and decreases in sexual behavior alluded to, there is no evidence that either of these ever took place. It's just that if you assume HIV is almost always transmitted sexually, things have to have happened as the orthodox account says they did.

Of course, sexual behavior may have changed in various ways; unsafe behaviors may have waxed and waned, just as they have probably done elsewhere and at various times. Since sexual behavior data has been collected with a view to getting HIV transmission under control, things have certainly waxed and waned in Uganda, which is often cited as the best example of a country where HIV prevalence dropped because the country did all the right things. But unfortunately, even though HIV prevalence has bumped along at a figure that still makes Uganda a medium prevalence country, sexual behavior appears to be thoroughly waxing at the moment, and not for the first time since their heroic success of the 1980s.

There's an article in the Daily Monitor about PEPFAR funded research which shows that plenty of the behavior considered to be 'unsafe' by that bastion of sexual safety still occurs in Uganda. "20% city students in sex trade - report" screams the headline. There are also figures about the number of young people conceiving, having abortions, having sex with relatives for money or gifts, underage sex, transactional sex, rape, oral sex, anal sex, alcohol, drugs and lots more.

These are all extremely worrying phenomena; but does anything about this research show whether they relate to HIV or how they might relate to HIV? Certainly, past research tends to show that a lot of HIV transmission does not correlate very closely with sexual behavior. And if the above trends in sexual and other behaviors among young Uganda people are increasing, why is HIV not also increasing? Perhaps that will follow. But there have been articles about increasing levels of unsafe sexual behavior in uganda going back many years.

There are the usual implications that HIV transmission is being 'driven' by things like higher vulnerability among girls/women, economic dependency, transactional sex, etc, and that people need education and what not. Which is all true, the bad things mentioned are indeed bad things and people need good things, many of which are mentioned in the Universal Declaration of Human Rights. But good things have not, despite the claims of the HIV orthodoxy, been unambiguously associated with lower HIV transmission and bad things have not been unambiguously associated with higher HIV transmission.

A report from Namibia shows that good and bad things also happen there but that, in contrast to Uganda, HIV prevalence increased among a large group of people being monitored for changes between 2006/7 and 2009. Figures were higher for females, as they are in most sub-Saharan African countries, but there was very little correlation with socioeconomic factors. And while HIV knowledge was 'strongly' associated with lower prevalence, most people didn't appear to know a great deal; 75% either felt they had no risk of being infected with HIV, or they didn't know or refused to answer the question.

The paper concludes that neither prevalence nor incidence are declining and that everybody in urban areas (the research was carried out in Windhoek) is at risk. But it is hard to know what to conclude from the data collected. Only 55% of the people surveyed in 2006/7 were surveyed again in 2009, suggesting that a lot of the conclusions could be quite biased (possibilities which are discussed in the paper). It's great that the research identified geographical areas "that would require prioritized HIV campaigning"; but do we know why so many of city dwelling Namibians, a lot of whom actually face fairly low HIV risks, are being infected?

The Ugandan research may show that high rates of 'unsafe' sexual behavior do not necessarily result in high rates of HIV transmission. But the Namibian research seems to show that researchers can't quite say why sexual behavior, whether high risk or low risk, seems to result in prevalence figures that are two or more times higher than those in Uganda. Ironically, the Namibian research was carried out with a view to "improving access to affordable health care". Access to health care in Namibia is very high compared to that in Uganda. It is despite very low access to poor quality health care in Uganda that HIV prevalence is medium, unlike in Namibia, where it is high.

Sexual risk is not the only phenomenon relevant to HIV transmission, neither in Namibia or Uganda or any other country where HIV is transmitted; there are also non-sexual risks, such as unsafe health care, intravenous drug use and unsafe cosmetic practices. Both of these accounts of HIV concentrate on heterosexual risk, as do most accounts of African HIV epidemics. Data collected generally relates either to sexual risk or relates to other phenomena that are thought to or are claimed to relate to sexual risk. Instead of tying themselves in knots to explain away data that doesn't support the orthodox view, it's time to reconsider the orthodox view. Wouldn't that be more scientific?

Circumcision: Non-Paternalistic Public Health is Possible in Africa, Isn't It?

After holding out for a while, apparently the Malawian government has now had a change of heart about male circumcision and has caved in to pressure from the international HIV industry to include the operation in its HIV 'prevention' strategy. There were good reasons for holding out: prevalence is a lot higher in the Southern part of the country, where almost everyone is already circumcised. While the headline figure is 'up to 60% less likely to be infected', there are many countries where men are more likely to be infected if they are circumcised, aside from Malawi (see table of HIV infections in circumcised and intact men).

The country claims to have circumcised 5,000 men already but they plan to circumcise another 245,000 by 2015, despite the conflicting evidence about the effectiveness of the program. It is also revealed that only 4% of the country's medical staff have been trained to carry out the procedure. That's extremely worrying in a country where there is such a shortage of medical staff, regardless of what they know about circumcision. Other research in Malawi has shown that living close to a health facility is a serious risk factor for being HIV positive. But I don't expect that to be mentioned in the evangelical literature.

The last sentence in the article is particularly badly phrased: "people still had to be reminded that male circumcision alone is not 100 percent safe". The sentence aims to express the idea that male circumcision on its own will not protect against HIV and the 'up to 60% protection' requires the use of condoms (which is why some people ask if the circumcision is even necessary). But sadly for Malawi, figures suggest that HIV prevalence is far lower among both males and females who never use condoms than among those who ever use them.

Another reason why the sentence is unfortunately phrased is that it sounds like it means the operation itself may carry risks which, ironically, is true. In addition to many unexpected HIV infections in male and female virgins, where prevalence was similar to or higher than that among non-virgins, there have also been questions raised about mass male circumcision programs, where some of those circumcised might have been infected as a result of the operation itself. In countries where health facilities are in such bad condition that they may carry as high or even higher a risk of HIV infection, mass male circumcision sounds like an extremely dangerous HIV prevention strategy, particularly in Malawi.

Meanwhile, Uganda claims to have already circumcised 600,000 men since 2009. Uganda has had quite a few probable healthcare associated HIV outbreaks, including during the Rakai circumcision trial, which is supposed to show that circumcision is a viable strategy for HIV reduction. There, the aim is to circumcise 4 million men, until HIV prevalence "reaches zero", which will be a very long time from now at the rate things are going. Notably, despite evidence for healthcare associated HIV transmission in Uganda, the ridiculous claim about 80% of transmission being through heterosexual contacts is still being made (and elsewhere it is claimed that almost 20% more is from mother to child transmission).

The article also claims that 768,000 men have been circumcised in Tanzania, against a target of 1.3 million. Strangely, it is also claimed that Kenya has only circumcised 76,000 men against a target of 860,000 men by 2011. Other claims have put the figure in the hundreds of thousands, against a far higher target, and that was just among the Luo tribe of Nyanza province, a few million people. Another country where circumcised men are more likely to be infected than uncircumcised men is Rwanda, and it is stated that they have already operated on 415,000 men, out of a target of 900,000.

Paternalism behind African 'public health' programs funded by Western countries is questionable enough, but can't these circumcision evangelists at least wait until the more dubious arguments been re-examined and until there is stable and convincing evidence for carrying out what is probably an unnecessary and clearly an unsafe operation on more than 20 million people? Jacques Pepin (in The Origins of AIDS) has shown the sort of damage that resulted from public health programs carried out in colonial days (motivated by a desire to maximize profits);  we now know far better than to carry out mass male circumcision programs, but it seems we're still going ahead with them anyway.


[For some of the less well publicized details about the three circumcision trials used to advocate for mass male circumcision, see the Don't Get Stuck With HIV website and blog.]

Gates to Unleash Destructive Agricultural Technology on Unsuspecting Tanzanians

An article in The Citizen opens with the statement: "Tanzania will not make significant gains in its endeavours to eradicate poverty through increased agricultural productivity if the doors to Genetically Modified Organisms (GMOs) are not opened." It seems he was quoting the minister of agriculture, who is a professor of some kind, but is also quite uncertain about the population of Tanzania.

The minister wishes for "more efficient use of resources, enhanced food production and higher farm incomes" and other nice things. He notes that three quarters of the working population are only contributing to 27% of the gross domestic product and says that low productivity is associated with poor agronomic practices and limited use of improved seed, fertilisers as well as lack of sustainable control of pests and diseases".

But Justin Sandefur of the Center for Global Development takes quite a different view. He criticizes the Bill Gates annual letter for what the man has to say about research that his Foundation is funding in Tanzania, probably the same research the above minister is welcoming, certainly a similar kind of research. Sandefur is entitled to have a view on this as he carried out some agricultural research funded by the Foundation in Tanzania. Perhaps I was wrong in suggesting that Gates doesn't have advisers who have the balls to stand up to him; perhaps he just doesn't listen to them.

Gates' optimism about innovation being enough to lift Tanzanian farmers out of poverty is contrasted with the fact that people leaving agriculture altogether has been the main source of poverty reduction. Sandefur finds that innovation is not very popular and most farmers don't use modern farming technologies. And as income levels in agriculture are much lower than those outside of agriculture, leaving agriculture is probably the best way of reducing poverty levels. This has been a trend for some time, apparently.

Sadly, Sandefur doesn't have much to say about the kind of technology Gates is particularly interested in, GMOs. These were not developed with lifting Tanzanians, or anyone else, out of poverty in mind. They were designed so those who controlled them would also control the people who grow them and the land and water where they are grown. Those who produce the GMOs also produce the agricultural technologies. That's what Gates is attracted by; I don't understand why he keeps mentioning poverty and the like but I assume it's a form of spin.

Sandefur also takes Gates up on his use of the terms 'population bomb' and 'global food supply shortages'. But Gates and his views on population are infamous; he thinks there are too many people in the world; especially poor people, whom he believes should have fewer children. But as his flunkies should be able to tell him, local food shortages are not due to a lack of food. It's just that poor people can't afford it, especially if it's being grown for export, by foreigners, for a big profit, on land that has been taken from small farmers.

I agree with Sandefur that there are limits to technological fixes but not that Gates should continue with what he is doing. GMOs are destructive to the food supply, to food security, to the economy and to the environment. Other Gates technological fixes, such as in health, can also be destructive. If more people leave agriculture, that may improve conditions for GMOs to take over, as they need very large amounts of land, a lot of technology and very few employees. But this doesn't improve the prospects of those leaving agriculture, nor does it address the problems of poverty and underdevelopment for Tanzanians as a whole. People who are poor and whose income is stagnating will only become less and less able to afford what they need to survive.

Gates doesn't have a plan for all those who stand to lose out under his proposed GMO technocracy, which is all Tanzanians, whether they work in agriculture or not. But non-GMO agriculture is in a far better position to increase food supply, ensure food sovereignty, improve nutrition, protect the environment and provide various advantages without compromising the current, very weak economy. The minister of agriculture may not wish to turn down Gates' philanthrophy but there's a good reason why Gates wants to do things in Tanzania and it has nothing to do with improving the lives of Tanzanians.

For more about GM and non-GM crops, see GMWatch.