Food Security Means Non-GM Food

Not content with contaminating their own country with genetically modified organisms (GMO), American GMO patent holders are busy getting politicians and other powerful people to help them in their quest to contaminate whole continents, such as Africa. African countries haven't proved to be the pushover that these GMO multinationals would like, but there are powerful people willing to give them a helping hand, such as Bills Clinton and Gates.

Despite spewing out the mantras about free markets and lowering barriers to trade, patenting is the ultimate form of protectionism. Owners of American GMO patents don't even need to grow their contaminants in America to reap vast profits. They can simply palm them off on poor farmers in far away developing countries, for whom GMOs are entirely inappropriate, and rake in the cash royalties.

The two Bills are supporting what is known as the Global Food Security Bill. Despite the name, this bill aims to foist GMOs on people in developing countries by dressing them up as aid. The idea is not a new one; public money is used to open up new markets for these thugs and they pocket the profits. Only the very rich and powerful will benefit from all this. But isn't that what aid is for?

For many years now, millions of dollars of 'aid' money has gone into developing a genetically modified sweet potato in Kenya. Strings have also been pulled to get some laws adjusted so that such crops can be commercialized. The problem is, this potato hasn't really taken off. Local varieties have performed far better in trials. To add insult to injury, breeders in Uganda have developed a virus resistant sweet potato using traditional methods while working on a shoestring.

GMOs of any kind would be a disaster for Kenya and for any other country. Just look at the problems the US, Canada, India, Argentina and Australia are having with their contaminants. But the organisms are particularly dangerous for developing countries. The last thing small farmers need is crops that cost a lot to grow (GM seeds are far more expensive than conventional ones), that develop serious yield and pest problems and that systematically destroy the ecosystem. But that pretty much sums up GMOs.

Anyone interested in reducing hunger should encourage sustainable agricultural practices that are appropriate for small farmers, because most farmers in developing countries are smallholders. They should steer clear of expensive and inappropriate technologies, such as GMOs. These were developed for rich, large scale farms, although they don't even seem to be benefiting them. For every advantage claimed for GMOs so far, conventional breeding practices have surpassed those claims. GMOs are not just unnecessary, they are highly undesirable.

Malawi Needs Good HIV Research, Not Bad HIV Laws

Malawi has this cunning plan to 'outlaw HIV transmission' by making it a crime to 'knowingly' transmit HIV. A spokesperson for the ministry involved said "The underlying factor is that if anybody knowingly infects somebody...that means he commits an offence." I haven't been able to find a copy of the bill but apparently it means that if a HIV positive sex worker fails to let partners or clients know their status, they will be liable to prosecution.

I wonder if their partners or clients will also be liable to prosecution for failing to reveal their status. After all, people availing of the services provided by sex workers should be equally aware of the danger of transmitting and of being infected with HIV, along with various other sexually transmitted infections (STI). The spokesperson was unable to say what would happen if both parties were HIV positive and referred to the bill as a challenge. He also said what they are doing is educating the populace. I assume he was trying to make a joke, however inappropriate.

I would also like to know where the law would stand with regard to non-sexual transmission of HIV. For example, where health services use shared needles, syringes or medicine vials or engage in other potentially hazardous practices, would they be liable to prosecution? Supposing they failed to take precautions specified under normal occupational procedures, how would the law stand? Could a HIV positive mother be accused of criminally infecting her child, either in the womb, during birth or through breastfeeding? Would a HIV positive intravenous drug user (IDU) be liable by sharing injecting equipment?

If you accept the received view of HIV transmission and believe that 75% of it is transmitted through heterosexual sex and only a very minor proportion through unsafe medical procedures, you may not worry about medical transmission (though this doesn't answer the questions about IDUs or transmission by mothers to their children). But if doubt were cast on that received view, if medical transmission were more common than previously supposed (admitted?), or if it were even more common than heterosexual transmission, you might consider the question more important, especially if you were a health professional.

The trouble with medical transmission of HIV is that it has received very little research. Figures you hear bandied about are mostly based on assumptions which should never have been allowed to stand untested, as they have been, for several decades. But among the few bodies of data that have been collected, medical transmission has been found to be a risk in almost all of them. This doesn't mean that medical transmission has been demonstrated, just that those receiving injections have a higher risk of subsequently being found to be HIV positive. Notable also is the fact that some of this research goes back to the mid 1980s.

Data from Malawi is the most shocking. 54% of HIV infections are found among those who have received injections in clinical settings. Other countries report lower percentages but the average is 21% and the mean is 19%. For me, the worst aspect of this is that none of these pieces of research are national in scale and only a handful of countries are involved (DRC, Uganda, Rwanda, Tanzania, Zimbabwe and Malawi).

The Malawian spokesperson is right in saying that there no straightforward answers to questions that arise about this proposed bill, but not for the reasons he thinks. If medical transmission of HIV is higher than has been previously assumed, it would be more worthwhile, indeed, more straightforward, to investigate this and provide some remedies. That would certainly be more feasible than trying to create laws of dubious ethical standing to reduce HIV transmission.

On the whole, it would be a good thing if HIV was less likely to be transmitted sexually because it is difficult to influence the sexual behaviour of whole populations and efforts so far have failed. In contrast, it should be much easier to influence the practices of existing health personnel, increase the number of trained personnel, increase the resources available to them and increase access to health services. And improving health services will have benefits that far exceed those to HIV alone. As to how providers of medical services can regain the trust they will have lost, that will be no easy matter. But I don't think anyone would opt for continuing to transmit HIV through medical procedures, if this is actually happening.

The admission that medical transmission of HIV could be higher than previously thought, and even that sexual transmission could be lower, may be a hard one to make. Of course, it may not even be true that medical transmission is higher and sexual transmission is lower. But now that the possibility has been raised, we can not continue to fail to research this vital area of HIV knowledge. Let us stop lying about what we don't yet know.

The Biggest 'Omission' in Medical History?

Sometimes you come across a theory that can explain so much that you wonder why you have been flailing around hopelessly for so long. One time I was looking around one of those electronics shops that you find in every terminal in London's airports. I was marvelling at the things that can be made and even purchased at fairly reasonable prices. Because I was studying development at the time, I was trying to think why the sort of ingenuity that that goes into these products, which were hardly vital to humanity, didn't go into development. The proto-theory I came up with was that some people just don't matter.

I was horrified that this thought could go through my mind just then, because it is a value judgement, not a scientifically testable theory. Surely it has no place in development theory, especially in the specific area of HIV research, a field peopled by some of the most brilliant scientific minds alive? But the thought never left my mind because it seemed to explain so many things. How else could you explain the way people in rich countries treat people in poor countries? The more I studied, the more I realised that some people believe that (or behave as if) other people don't matter, either because they are far away, they are foreign, they are poor, they are sick and needy or are just not worth considering.

While studying HIV, I was unconvinced that the entire explanation for the rate of HIV transmission, in some countries only, could be explained purely by differences in sexual behaviour. I was equally unconvinced that so called HIV prevention programmes could possibly have any influence on sexual behaviour. And when countries boasted about how successful they were in reducing HIV transmission as a result of these prevention programmes, I thought they were unclear about why HIV prevalence had dropped and didn't really care why, they just used the circumstance for publicity.

I had to limit my study to make it manageable and did so by concentrating on heterosexual transmission of the virus, since it is the received view that this is the main mode of transmission in countries with a generalised epidemic, such as Kenya. And it turns out that that is one highly dangerous received view, for many reasons. Heterosexual transmission of HIV is definitely one mode of transmission, but the extent to which it drives generalised epidemics is completely unclear, and it always has been.

So my objection to the main players in the HIV industry is this: why has so much money and effort gone into programmes that assume the precedence of heterosexual transmission when this is just an assumption? The whole idea that there are some people who have more sex than others, or more sexual partners, or who are more likely to engage in unsafe sex, is a value judgement. But it is the value judgement that has launched a thousand careers for politicians, religious leaders, social and religious leaders, professionals of all kinds and who knows what else. It is a value judgement that drives global HIV prevention policy and spending.

There are many warning signs that heterosexual transmission of HIV does not explain extremely high rates of transmission in some countries. No credible correlation has ever been found between rates of transmission and levels of the kind of sexual behaviour that would be required to drive the sort of epidemics found in Kenya, South Africa, Lesotho, Swaziland and anywhere else. There are so many contradictions and non-correlations that many professionals in the HIV industry must have been asleep since some time in the 1980s, because there were obvious problems with the sexual behaviour paradigm even then.

Even back in the 1980s, not long after HIV was identified as the virus that caused AIDS, medical transmission was recognised as one of the possible modes of transmission. Small amounts of research went into establishing the extent of unsafe medical practices and the results suggested that these practices could transmit HIV to many people. But little further research was carried out. WHO, various UN agencies, leaders of all descriptions, professionals of all descriptions, various globally represented organisations, institutions, universities and others flew the flag for heterosexual transmission of HIV in developing countries (though not in developed countries). There were few exceptions and they were considered to be denialists or trouble makers. There are still few exceptions and they are still considered to be denialists or trouble makers.

Well, maybe medical transmission of HIV is not very high, maybe it is lower than heterosexual transmission. Maybe all the fuss is about nothing and maybe I'm just one more person poking his nose in where it doesn't belong. But that is the point: I want to know why medical transmission of HIV has not been properly investigated, why it is still dismissed as being almost non-existent. The recently published (though based on out of date data) Modes of Transmission Survey for Kenya suggests that medical transmission accounts for 0.6% of all transmission, based on an assumption that seems to have been pulled out of thin air. They also note a finding that puts the rate at 2%, over three times higher. But this is still dwarfed by most of the other modes of transmission, especially heterosexual transmission.

But those who are still being branded as mavericks for questioning the received view point to many bodies of data that have managed to investigate medical transmission rates of HIV. Those bodies of data show that medical transmission is very significant, perhaps even more significant than any other mode of transmission, including heterosexual transmission. All they are asking is that these results be taken seriously and subjected to rigorous testing. If medical transmission of HIV even stands at 5%, this would still account for millions of people currently living with HIV and hundreds of thousands of people who have died of HIV.

One of the most heartrending things about people dying of HIV, as opposed to other diseases, is that they are, because of the unexamined and long held value judgements of so many 'brilliant minds', vilified, ridiculed, shunned, persecuted, sneered at and humiliated just when they are in most need of sympathy, love and basic humanity. If it is even remotely possible that we as people are guilty of such terrible injustice to fellow human beings, surely that is in urgent need of investigation? Far from dying because they have engaged in what may or may not be risky sexual activity, people may be dying because they have followed the advice of well educated professionals.

It's almost unthinkable that much, or even any, recent cases of HIV have been transmitted by the very professionals that are supposed to be preventing and treating HIV. But it is even more unthinkable that we could suspect such a thing is happening and do nothing about it. Maybe there is a danger that people will stop going to health professionals and stop seeking medical treatment, even vital vaccinations and life saving treatment, because of a complete lack of confidence in the profession. But that is something the profession will have to deal with because they certainly don't deserve any confidence or respect until they have fulfilled obligations that have so long been outstanding. In fact, in some countries, going to the doctor may curently be a health hazard, carrying risks of infection with HIV and many other blood borne diseases.

In the field of HIV, nothing is more important right now than establishing the extent of HIV transmission through medical treatment.

European Protectionist Agreements

Recently, I expressed a sceptical view of the EU's proposed Economic Partnership Agreements (EPA) with African countries. I suggested that while the EU pretends such agreements are for the benefit of Africans, this is just a sham and that they are unashamedly beneficial to rich countries and detrimental to the development of poorer countries. The former president of Tanzania, Benjamin Mkapa, is in agreement with me, warning that EPAs are a form of neocolonialism. The EU have been quick, but unconvincing, in their denial of any underhand intentions.

Their response is unconvincing because they are effectively just offering more of the same. African countries will produce low value goods and raw materials, which the EU will buy for as little as possible. In return, the EU will sell African countries high value products that have been produced cheaply, in part, because of the low raw material costs. Sometimes, these high value goods will even be produced using badly paid Africans, which will further increase the profits for the EU. The EU assures African countries that they will be allowed to phase out some tariffs more slowly than others. But ultimately, the EPAs need to obey the strictures of the WTO (World Trade Organisation), where 'world' means 'rich countries, especially the US'.

While the EU is pumping out the woolly rhetoric about African countries removing barriers, they are piling up the barriers to make it more difficult for African products to reach the EU markets. It's the time honoured process of protecting their markets while accusing weaker economies of protecting theirs, a process particularly relished by the US and UK when it suits them, only to be replaced with a sanctimonious plea for free trade when the conditions are right.

Incidentally, a piece of particularly woolly rhetoric is the 'Agreement on Sanitary and Phytosanitary Measures', which you may need to read several times only to remain totally confused. The EU can insist on certain standards for food coming into the region that make exporting by African countries to the EU too expensive. According to these measures, that is not what is supposed to happen, but it effectively means that most African countries can't export to the EU. And the EU supports those exporting goods to African countries by methods that would be considered to be subsidies if they were implemented by Africans.

Even the private sector in Africa is suspicious of EPAs and they are the people who may be expected to have most interest in them. So if the private sector and other influential people are not about to be hoodwinked yet again by the protectionist West, perhaps there is hope that African countries will have some influence on other trade issues that have, so far, kept most of them underdeveloped.

Medical Transmission of HIV May Be Widespread in African Countries

A couple of weeks ago I was taken to see a woman in a rural area who was very sick. She was terribly emaciated and the place she lived in had clearly not been looked after for a long time. The woman insisted that she did not have HIV, although she also claimed not to have been tested. After a few days, she was taken to the local health centre. There, it turned out that she had already been tested for HIV, was found to be HIV positive and was put on antiretroviral drugs (ARV). But she refused to take the drugs and agreed to be sent home, as the health centre was unable to do anything for her. She died about one week later.

All we could do was insist that she went to the health centre to be tested and take her drugs. She reluctantly went to the health centre but refused to take her drugs. It was as if that was all that was left to her to preserve her dignity. For some time, she had refused the advice of neighbours and health volunteers. And they were growing less willing to visit her, because they knew that she was going to die. On the day she went to the health centre, she looked humiliated and perhaps even angry.

The stigma that still attaches to HIV/Aids, and even TB because of its association with HIV, may seem like a sticking point that results in people wishing to deny that they have been infected, even when the cause of their illness is undeniable. But the stigma is real. People are ostracized and treated differently because they have a disease that is associated with illicit sexual activity, either on the part of the sick person or on the part of someone with whom they are intimately connected.

The 'behavioural paradigm' for explaining HIV transmission is widely adhered to and informs most HIV prevention programmes. From the extremely naive ABC (Abstinence, Be faithful, use a Condom) to the downright foolish mass male circumcision (MMC) campaigns, the assumption is that because HIV is mostly transmitted by sexual intercourse, all we need to do is get people to change their sexual behaviour.

So far, I have accepted the often published claim that most HIV is sexually transmitted. But I have argued that the circumstances in which people live and work, for example, may determine who they have sex with, when and under what conditions. Trying to influence their sexual behaviour without examining these circumstances too, will result in a lot of failed prevention programmes. Most prevention programmes to date have, indeed, failed.

But perhaps, while rejecting the behavioural paradigm, I have fallen into the trap of accepting something like a sexual paradigm, that most HIV transmission is sexual transmission. Perhaps this is not even true. I was aware that there were people arguing that non-sexual, particularly medical transmission, could be far higher than accepted by many theorists. But I had to exclude certain lines of enquiry in order to limit my dissertation to a manageable field. Now that I am no longer so constrained, I have time to revise this limitation.

If medical transmission of HIV is significantly more common than supposed by most HIV analyses, a lot of questions could be answered. For example, perhaps more women than men, especially women of childbearing age, are infected because they receive more medical treatment. Perhaps many children who have been infected, especially those whose mother is not infected, have been infected by medical treatment. Perhaps the reason those in Northern Kenya, who have least access to modern medicine, also have very low levels of HIV because they are not being infected by medical procedures.

I have been reading a book by Daivd Gisselquist called Points to Consider: Response to HIV/AIDS in Africa, Asia and the Caribbean, conveniently published on the internet. Some of the things revealed in this book are truly shocking. When I have finished, I have to go through everything I have written about HIV and reconsider my whole view of it. My view of development will probably remain the same, but the way I reached some of my conclusions will have to be revised, considerably.

If Gisselquist and others are right, and I have no reason to believe they are are wrong, the woman who refused to take her medication could have been a victim of stigma, not primarily emanating from her own neighbours, but from some of the most eminent health professionals in the world. That HIV is primarily sexually transmitted in African countries is a long held, received view. Because of this received view, people who say they have not had sex in the period in which they became infected have not been believed. Women who are infected when their husbands are not are assumed to have had extramarital sex. Where couples are infected with different strains of HIV, they are both assumed to have been promiscuous, rather than just one of them.

This received view is in need of thorough testing and it is incredible that it has been used to face down challenges for so long. The view has shaped most of the (highly unsuccessful) prevention campaigns, but also people's reaction to their being infected with HIV or the reaction of others when faced with someone who has been infected. How many innocent people may have died in shame, misery and isolation because the health profession has refused, for whatever reason, to investigate its poorly supported assumptions about frequency of transmission of HIV in medical contexts?

Excessive Drug Prices Promote Counterfeit Drug Industry

According to the WHO, lifesaving drugs are not exempt from the trade in counterfeit medicines. But nor are they exempt from the rights of powerful multinational pharmaceutical companies to make obscenely high profits, regardless of the cost in terms of sickness, suffering and death in developing countries. Organisations like WHO and Interpol (effectively, publicly funded) are busy trying to help these poor victims, the pharmaceutical companies, that is. Otherwise, their ability to extract higher and higher profits every year may be compromised.

Yes, the WHO is right, it is cynical to produce counterfeit drugs, some of which may not help the person taking them; some may make them worse or even kill them. But it is also cynical for Big Pharma to put such impossibly high prices on drugs, spend far more on marketing and lobbying than on research, compromise doctors and other health professionals to push their products, produce goods for the rich world while ignoring the poor majority, using people in poor countries as cheap research fodder for drugs intended for the rich world, preventing poor countries from producing and making generic equivalents of overpriced branded drugs, lobbying the WTO (World Trade Organisation) to make laws that protect Big Pharma at the expense of poor countries and generally frustrating any attempts to regulate them, even slightly.

I don't know how many people die from counterfeit drugs but I know that an estimated 14 million die every year from infectious diseases, many of them preventable or treatable. The policies of Big Pharma ensure that the majority of people who need drugs most will never be able to afford them. A notable exception is antiretroviral drugs (ARV) for HIV, which have only been reduced slightly in price and only because they are being paid for by aid money. And no one need worry that production of ARVs on a massive scale at slightly reduced prices causes Big Pharma to suffer in the least. If they didn't get the HIV industry to buy their drugs, the market for them would be miniscule in comparison to what it is now.

So the humbug WHO claim to be worried about ordinary people being exposed to counterfeit drugs. But this is just an excuse to use lots more public money to protect the interests of Big Pharma. Already, public money has gone into the research the pharmaceutical industry claims to do. But most of the costs of drug research are met by publicly funded bidies, such as research institutions, laboratories and universities. Then the drug companies slap a patent on the results and pocket all the profits. If the WHO was really concerned about endangering the public they would lobby Big Pharma to do one simple thing: lower their prices.

But that is one thing the industry will not do. Far from it, they will continue to lobby to be protected so that they can continue to make far bigger profits than most other industries. Lowering their prices, or even lowering their prices to affordable levels for drugs needed most by developing countries, would have little negative impact on their profits. In fact, like with HIV drugs, they may discover a market they have long been ignoring. But they would prefer to fight for their right to charge more than people in developing countries can afford, perhaps by lobbying for aid money to be spent on drugs other than just ARVs.

As long as patented drugs continue to be too expensive for people in developing countries, it will be worthwhile for counterfeiters to target them with their products. As long as Big Pharma lobbies against the production and distribution of generic versions of patented drugs, people in developing countries will have no option but to look for cheaper alternatives. Big Pharma, in its efforts to maximise its profits, is creating the ideal market for counterfeiters. Getting Interpol and the WHO to spend increasing amounts of money and creating more sophisticated law enforcement systems is pointless. Counterfeiters will also become more sopisticated, as they are amply demonstrating.

Why? Because there is good money to be made. Pharmaceutical products don't just include drugs, the number of products that are artificially overpriced because they are produced by this industry is enormous. Who wouldn't grasp the opportunity to take advantage of the opportunity to produce relatively cheap products that can be sold on at ridiculous prices, only slightly less ridiculous than the prices charged by Big Pharma?

It's because I sympathise with vulnerable people, mainly in developing countries, that I think that drug counterfeiting should be stopped. It's not because I think the pharmaceutical industry should be allowed to hold the world to ransom. But I think the industry itself is creating the problem. The cost of drugs needs to be reduced to make them affordable in developing countries and it needs to be possible for developing countries to produce and/or buy generic equivalents of life saving drugs because they will never be able to pay the prices currently demanded by the industry.

The Pretence of Aid

Some of the issues this blog is particularly concerned with include unfair trade policies that aim to keep developing countries in their current state of underdevelopment, the use of developing countries to produce low value goods and raw materials, but not high value goods, which they have to import from rich countries, and the use of developing countries for growing monocultures and single resources that are often processed in rich countries, earning poorer countries very little.

Economic Partnership Agreements (EPA) are, to a large extent, behind these and other issues. Rich countries have been busy for a long time trying to persuade African countries to sign up to these EPAs, without much success, yet. But as the number of poor people in African continues to rise, mostly as a result of the 'pro-poor' policies of rich countries, it should be possible to persuade more countries to put the noose around their neck in return for some short term handouts that they need for an emergency.

Perhaps Kenyans think there is no alternative, perhaps there is no alternative for them, but they seem to be getting further and further into the noose of producing cheap primary goods for export. Huge areas of land are being diverted to use for biofuels and other things that people here are not in great need of. At the same time, small farmers, who produce the bulk of what Kenyans eat, are slowly losing access to land as they are pushed off by rich industrial scale agricultural interests and as the prices rise to levels they will never be able to afford.

Rich countries used trade tariffs to get to the position they are in today. Now they want poor countries to remove their tariffs so that the rich countries can expand their markets and compete, under completely skewed conditions, against the poor countries' markets. EPAs are dressed up as being advantageous to African countries but so far, most African leaders have not been fooled.

The East African press generally seem uninterested in non-national matters, so I was surprised to come across an article that discusses the difficult area of EPAs in simple language for a non-political economist like myself to understand. This article sees EPAs as the wrong kind of development model and discusses a number of key points. One of these concerns EPA provisions that are highly detrimental to African countries' development. The EU claims that dismantling tariffs will promote growth, despite the fact that this has never been the case, in any country, or at any time in history. On the contrary, tariff cuts have taken countries in the oppostie direction, leading to stagnation and de-industrialization.

Kenya is typical of the countries who will suffer if they sign up to an EPA. They depend on a handful of low value primary goods that are often produced by farmers at an extremely small profit, even at a loss: sugar, sisal, coffee, tea, fruit, vegetables and the like. It would be extremely advantageous to Kenya to use those primary goods to supply an industrial sector, if they had an industrial sector. But much of the industry they do have is owned by foreigners from rich countries, who are effectively subsidized to be here. They get tax breaks and other incentives so that Kenyan industrialists have no chance of competing with them.

Of course, the EU would not want Kenya to develop an industrial sector, not an indigenous one, anyhow. Their economies depend on cheap goods and cheap labour from developing countries. So they dress  up their policies and 'contributions' as 'aid' and they talk the talk of development. And for the EU and other rich parties, African countries are not just sources of cheap goods and labour, they are also important markets, where very expensive goods, often made with cheap African raw materials and labour, are either sold or dumped on the African market.

It's a disgusting thought, but all the land that has long been used to produce non-food or non-essential food products in developing countries could have been producing food for starving people here in Africa. Instead, starving Africans get a pat on the head and a hand-out from the rich world. Now that some rich countries are unable to produce enough food for themselves, they are buying up African land. Others are buying up African land to produce biofuels. Africans can expect more pats on the head and more hand-outs whenever enough Western attention is drawn to some drought, flood or other 'natural' disaster.

And don't be fooled into thinking that most of the disasters that strike poor countries are wholly natural. Many are not in any sense natural. People starve, become sick and die during what are referred to as disasters, usually, because they don't have access to the food or the water that is being extracted by foreign interests. The 'shortages' of food that Kenya has experienced recently and will continue to experience into the future have been manufactured. The bulk of land, and therefore water, in Kenya is devoted to producing goods for export. Even those goods that consist of food items are destined for Europeans who can afford it, not Kenyans, whose buying power is undermined by various agreements with the EU and other rich countries and zones.