Global HIV/AIDS Policy is Not All Lies; that's what Makes it so Dangerous

Using this blog, which takes my MA dissertation as its starting point, I have fought against certain prevailing ideas relating to HIV. For example, the idea that HIV should be exceptionalized. Exceptionalizing HIV distorts health funding and diverts resources that should be balanced out according to the relative needs of different health problems.

Another idea I have fought against is that of the sexually incontinent African, whose animalistic sexual and social behavior needs to be kept in constant check by the restrained and wise but also exceedingly generous Westerner. And the list goes on.

Often, I use papers and articles that don't aim to make any of the points I wish to make, yet they may throw some light on important issues, sometimes ones that contradict the author's intended point. These papers, interestingly, are usually by clinicians, scientists, epidemiologists and the like.

But sometimes I am able to cite authors who agree that Africans are people too, that HIV is not all about sex, that it is not possible for extremely high rates of transmission to be explained by any existing data about human sexual behavior and that other forms of transmission, which are common in low prevalence countries, are probably also common in high prevalence countries. These papers are usually not by the abovementioned sorts of academic.

So this article by Michael Grimm and Deena Class, both economists, is very welcome because it gets straight to the point: the amount of money still being spent on HIV exceeds that available for other health issues, many of which are responsible for far more morbidity and mortality than AIDS. They also point out that figures relating to HIV have been systematically exaggerated, including those about how much developing country economies suffer as a result of high rates of HIV transmission.

But most importantly, the authors argue that the relative contribution of sexual transmission in high prevalence countries claimed by UNAIDS leads to vast sums of money being spent on sexual behavior change programs, which have had little or no impact on HIV transmission.

The authors suggest that blood exposures in health facilities, along with less formal settings where people can also receive medical treatment, may account for a far higher percentage of HIV transmission than the risible 2% or less estimated by UNAIDS.

They don't mention other settings where blood exposures are also a possibility, such as tattoo parlors, beauty salons, hairdressers, roadside manicure and pedicure services, etc. But it's the non-sexual bit that counts!

This should all be good news for UNAIDS, or whoever takes over after everyone finally admits that they have screwed up, bigtime. Influencing sexual behavior is difficult, as the HIV industry's failure to come up with a viable strategy demonstrates all too well. But influencing health care procedures should be a lot easier.

In fact, most countries which have seen significant declines in HIV transmission since the epidemic peaked, and that includes most high and medium prevalence countries, have already probably started reducing non-sexual transmission. Blood donations may not be as carefully screened as the UNAIDS blurb would have us believe, but a lot of work has been done in this area.

Injection practices have changed a lot in many countries. There are autodisable syringes, which break after use so they can't be washed and reused. There are pre-filled syringes, one syringe per dose. Many people have been trained in recognising the potential for blood borne infection and some have even been supplied with the means to reduce infection.

Indeed, some would argue that the sudden and unexplained increase in sexual behavior that would be required to explain why HIV ever reached such high levels in a few countries, never occurred. Rather, the virus only took off once it got into health facilities, unrecognized and therefore uncontrolled.

The equally sudden and unexplained decrease in sexual behavior required to explain why prevalence subsequently peaked and dropped, before the useless sexual behavior programs even started, also never occurred. Much of the effort required to reduce HIV transmission took place in health facilities in the 1980s and 1990s. And the efforts even continued after UNAIDS was established, only to derail the whole process by obsessing about sex.

But these matters are all in serious need of investigation. Many hospitals in African countries don't have the supplies and equipment they need to ensure that people are not infected though unsafe healthcare. Many lack the training and supervision required. There is still a lot of work to do, as attested by UNAIDS' own warning to UN employees to avoid African hospitals.

As Grimm and Class point out: "it is telling that an HIV outbreak investigation (genetic sequencing of HIV genetic material to match specific viruses from different infected persons) has never been conducted in any high-prevalence African setting."  This is despite compelling evidence in Mozambique, Swaziland and other countries that nosocomial infection (infection through medical procedures) continues to be vastly underestimated.

UNAIDS used to claim that everyone is at risk of HIV infection, even long after it was obvious that this is not the case. But in African countries, where an unknown and probably significant percentage of transmission is non-sexual, everyone who uses health and cosmetic services is at risk of HIV infection. Will UNAIDS break their long tradition of ignoring evidence that their policies are useless?

If It's Not PR, it Will Probably Never Get Published

But if it is PR, it will be bounced about like a genuine human interest story. You may have read about Coca Cola being the only institution that gets to the remotest villages in Tanzania? And that's why the unscrupulous multinational will now receive large sums of money to distribute their toxic products?

In fact, there are many products that reach even the remotest villages, too many to list. If there's money to be made, naturally, someone is there to provide the transport. But in Tanzania, we are led to believe, no one has that sort initiative, except Coke.

So, in a 'public-private' partnership, Coke will distribute antiretroviral drugs to HIV positive people. For those won don't know, the 'public' bit means that money destined for aid work goes to private industry, often without any question of competition, appropriateness, effectiveness, etc.

It's interesting to bear in mind that the remotest villages usually have the lowest rates of HIV. But those same remote villages are most in need of cheaper drugs for things like respiratory problems, diarrheal diseases, intestinal parasites, drugs that are so cheap, even Coke can't make a profit from distributing them.

Will Coke distribute anything else that HIV positive people need? Or is it just drugs? Surely the care of HIV positive people requires more than just drugs? How about trained personnel, medical facilities and equipment, day to day medical supplies? But no, Coke is not interested in helping to develop Tanzania's health infrastructure. That would be too much like philanthropy.

And talking of philanthropy, those paragons of the stuff, Gates and Co. are involved in Coke's generous measures to increase their profits and possibly bolt on a (very) small part of the country's ailing health infrastructure. In fact, Melinda Gates is one of the people who has often trumpeted the plight of poor Coke, who are so generous that they need aid money to help increase their profits to extortionate proportions.

Incidentally, Gates mentions the Mererani Tanzanite mine and how hard it is to reach it from Kilamanjaro International Airport because of the state of the roads. I don't think the roads would still be in such poor condition if the mines had to depend on them. And Gates didn't mention the fact that the mine has an unenviable record itself, with a minimum wage of 120 dollars, despite its massive profits.

Make no mistake about it, there are many enterprising Tanzanian transporters and distributors who would willing take on the job of distributing drugs, not just HIV drugs, and at a fraction of the cost that Coke will be extracting from the cause.

The article does mention a little about Coke's foul record when it comes to corporate social responsibility but focuses on the multinational's supply chain. Yet, there are others in Tanzania whose reach is just as broad as Coke's. The article would be better to expose the 'story' for what it is, blatant PR. Though you can't expect the Gates Foundation to notice these things; strengthening multinationals is one of their main aims.

Gates Wants to do for International Development what he did for Software

Continuing the theme of copying drug pushers' trick of giving away free drugs to get people hooked, the Gates Foundation has been at it again. They actually boast about 'giving' farmers free 'drought tolerant' maize seeds. Well, firstly, drought tolerant maize doesn't work and secondly, giving someone genetically modified organisms (GMO) is like giving someone HIV. They will risk giving it to others before they realize they are infected and they will not be able to get rid of it.

That may sound a bit harsh, especially to those who think that people like Gates is doing a great job in Africa, looking after agriculture, health, education and just about everything else. But GMOs are not, despite claims to the contrary, sustainable. If the farmer falls for the Foundation's lies, they may be stupid enough to start buying this contaminated maize seed. But they will find that yields are no higher than before and the costs are higher, the costs of the seed, the fertilizer and the pesticides. And the costs increase rapidly so that in a few years, profits will be far lower than the farmer is used to.

An article that purports to be written by a small scale Kenyan farmer, but is in fact by a Gates (Alliance for a Green Revolution in Africa or AGRA) employee who has a bit of land, talks about small farmers being the future. But GMOs are not appropriate for the sort of small farmer than make up 70-80% of African farmers, those with a few acres of land, at the most. These small farmers will disappear because Gates model involves farms that are large enough to be mechanized, at least to some extent.

Apparently Gates is aware that the majority of farmers will go out of business and end up unemployed in cities, but so far he hasn't found a way of exploiting them. Not that he has mentioned, anyhow. I'm sure he'll let us know when he thinks of one.

This Gates employee also bemoans the fact that he couldn't find the right type of seed for local conditions. This is ironic because most GMOs are one size fits all, a complete removal or all crop diversity, the opposite to what African farmers need. And world seed markets are almost all sewn up by a handful of multinationals who also happen to be the biggest proponents of GMO. Nor is it a coincidence that these multinationals work closely with the Gates Foundation.

The Foundation claims that it has invested millions in seed research but that it places very little emphasis on GMOs. What they place emphasis on is any kind of proprietary product, as opposed to the system many farmers use of selecting a good stock of seeds from each year's crop. The Foundation's work may or may not involve genetic modification but the effect on the farmer is the same, it impoverishes them. And the Foundation has invested a lot in GMOs, they just seem to be a bit ashamed of it.

The so-called 'golden' rice is an example. It doesn't work, it's expensive, but it's just the kind of dirty trick that the Gates Foundation enjoys, probably something they picked up from the Microsoft Corporation. The Foundation has a similar model for health. That's pills and vaccines for everything when basic healthcare, clean water and improved sanitation, good nutrition and better living conditions would do far more for people than all the technical fixes in creation.

Gates has spent a lot of money showing that he knows nothing about development, health, agriculture or, indeed, democracy. His intention appears to be to render these fields into his own model of how they should be, that is, dominated by technology that is wielded by a few rich multinationals. Frequently Gates, the Foundation or one of their mouthpieces rants on about education or lack of education and the plan seems to be to 'educate' people, by telling them all about how great the world will be if people would just think like him, it or them.

There is a sense in which Gates wants to do for international development what he did for software. And the important thing is whether you think that's great or whether you think that's a disaster. I think it's a disaster.

Gates 'New' Model of Development is the Old One, But With Higher Returns

The biggest producer of genetically modified organisms (GMO) in the world is the US, by a very long shot. The EU doesn't produce them comercially at all. So why is the number of tons of cereal per acre the same for both geographic regions? If GM is the answer, yield per acre should surely be a lot higher in the US. Of course, the figures could be rubbish, I got them from the Gates Foundation site.

The figure comes from one of Gates' sick-making speeches about Nora's goat, Tommy's piles or some happy, healthy (but African) toddler's ambitions to be prime minister. But behind the sugar coating there is, apparently, a pill; a pill to cure all of Africa's problems.

You might think that pill is GMO, but that's just one of a range of pills that have something in common: intellectual property rights have that not expired.

The strategy starts with "Innovation in seeds [which] brings small farmers new high-yield crops that can grow in a drought, survive in a flood, and resist pests and disease".

Some comments are in order. The majority of crops that have all, or even any of these advantages, are not genetically modified. So, no sugar for them. And these crops, whether GM or otherwise, are not developed, despite Gates' constant reference to them, for small farmers.

The few GM crops that have any of these advantages, none of them have all the advantages, also have some serious disadvantages, what Gates might call 'challenges'. For example, the seeds cost a lot more than conventionally bred seeds, resistance to pests gives rise to resistant pests, giving rise to further costs, etc. I say 'etc' because no commercially available GM crop has been developed with resistance to flooding or drought.

"Innovation in markets offers small farmers access to reliable customers." Now, what markets would he be talking about? The World Food Program and it's 'Purchase for Progress initiative, supported by Gates, which purchases a proportion of food aid from developing countries, or aims to. Apparently one of the Noras or Tommys quadrupled their income in one year as a result of this program.

Or perhaps Gates is talking about the US and EU markets, which subsidise some of their farmers so heavily that cotton and sugar, for example, can be grown more cheaply in the richest countries in the world than they can be in the poorest? Could the US and EU become 'reliable customers'? As things stand, the EU will cease to be customers as they don't accept any GMO contaminated foods for human consumption. So they say, anyhow.

"Innovation in agricultural techniques helps farmers increase productivity while preserving the environment – with approaches like no-till farming, rainwater harvesting, and drip irrigation." No-till farming may or may not require the use of GMOs. But rainwater harvesting and drip irrigation neither requires nor excludes them. The question is, will the Foundation require GMOs or, at least, crops that involve rich country protectionism, in the form of intellectual property rights? I'm guessing that not a lot of money will be spent on these 'challenges'.

"Innovation in foreign assistance assistance means that donors now support national plans that provide farming families with new seeds, tools, techniques and markets." So the rich countries that are making so much money screwing poor countries are going to suddenly concentrate their efforts on alleviating poverty that they have gone to so much effort to create? Keep dreaming Bill.

Following 'Purchase for Progress', there is now 'Feed the Future', of which Gates is also a keen supporter. And why wouldn't he be, with some of the top names in agriculture and food multinationals behind it?

Bill says his strategy has nothing to do with the "old aid model of donors and recipients". Actually, it has everything to do with the old aid model: it guarantees that the model of giving to people from whom you know you can extort a hell of a lot more will work far better if you also take control of the recipients' means of production. That's what's wrong with GMOs and with Gates.

Imposition of Genetically Modified Organisms Will Destroy Tanzanian Economy

A study of research articles about genetically modified organisms (GMO) finds that much research is highly influenced by commercial interests. Those funded by the industry or carried out by people connected with the industry almost always have conclusions that are in favor of further commercialization. Studies without these conflicts of interest tend not to favor further commercialization.

Of course, many 'studies' and articles don't declare their interests and it is beyond the scope of most people to figure out that much of what is available is profoundly biased. But where funding sources are declared, there is unlikely to be any close connection between the authors and the GMO industry.

A common tactic when writing about GMOs is to use some kind of scare story that has been put about by a media that sees news as a form of entertainment, rather than a source of potentially vital information. One of these scare stories is about GMOs 'saving' humanity from disaster, especially where shortages of food may be involved.

Thus, an article claims that the banana is in danger of extinction in Ecuador within ten years because of a serious disease. I believe the ten year claim has already been around for about ten years and the banana is not yet extinct. But the article says genetic engineering is the only hope. Similar remarks have been made about bananas in Uganda and about other staple crops elsewhere.

There are also claims about GMO crops giving higher yields than conventionally or organically bred crops. Often, slight increases in yields are only temporary. More frequently, higher yields are not realized in real-life situations. Agricultural inputs, including the seeds, are far more expensive. And quantities of fertilizer and pesticides required have tended to creep up until the soil and the water are seriously contaminated and resistance results in GM crops ceasing to be feasible.

Monsanto and others in the industry have been trying to sneak their sub-standard and very expensive products into developing countries for a long time, with a lot of help from their well lobbied and well paid political friends. It may sound tempting when you hear about a high yield crop that does well even when there is a drought, when the soil is poor, etc. But such magic crops don't actually exist, except in the publicity material of GMO manufacturers.

Despite the industry's lack of success in producing anything that performs better than conventionally bred seeds, 'drought resistant' corn is being approved by the US Department of Agriculture. The destructive tactic of GMO manufacturers, designed to make farmers entirely dependent on the manufacturer, is also being championed by well known philanthropist, Bill Gates, who can't resist anything where intellectual property is involved.

Considerable opposition has been raised against the imposition of GMOs on Tanzanians, who have been blasted with unfounded claims about their virtues. But it remains to be seen how successful a country like Tanzania can be in resisting something that will probably be distributed free at first. This technique, said to be favored by drug pushers, may be enough to allow GMOs a foot in the door. If that happens, it is unlikely the country will be able to reverse the process.

Tanzania is not in need of a technology that costs substantially more than other alternatives. Farmers do not need more expensive inputs, especially not inputs that need to be increased every year, or ones that increase in price every year. The country does not need its land to be taken over by foreigners or its millions of small farmers to be replaced by a handful of rich landowners.

The majority of Tanzanians live in rural areas and depend directly on agriculture for their food and their income. The imposition of GMOs would wipe out the biggest source of employment and subsistence in the country. It would also destroy the country's ability to sell their products in Europe, one of their biggest markets. The only people to profit from GMOs are those connected with pushing them; everyone else loses out.

Literacy as a Source of Ignorance

A review of a film entitled 'Shame in the time of cholera' mentions, as so many articles do, the role of illiteracy in such epidemics and how high levels of illiteracy make it difficult to disseminate information on how to avoid cholera.

High levels of illiteracy are a disgrace in the 21st century and make efforts to improve health conditions very difficult. But it is worth comparing illiteracy in poor areas with the sort of priorities rich and powerful people make about the health of those in poor areas.

Telling people to wash their hands, keep their houses clean, be careful about sanitation and personal hygiene, etc, is like a sick joke when there is little or no access to clean water or basic sanitation facilities (I'm not criticizing the film maker or the reviewer here).

And there may well be all sorts of stories about cholera coming from the wind, witchcraft, miasmas, etc, but there is also the story about cholera epidemics being prevented by drugs and technology and other great human feats.

But are people supposed to take these drugs and use these technologies in the absence of improvements in water, hygiene and sanitation? If so, the exercise will fail. Cholera and other water borne conditions were eradicated in Western countries, not by drugs, but by clean water, modern water infrastructures and sanitation facilities.

Some people and insititutions seem to think that they can pick out a few diseases, such as cholera and polio, and produce vaccines for them. They think that distributing these drugs far and wide will reduce morbidity and mortality, but they are wrong.

People treated for a handful of diseases will simply suffer from, and some will die from, other water borne diseases unless the whole issue of water and sanitation is addressed (and, of course, nutrition, health in general, education, social services, etc).

A name (of a person and an institution) that springs to mind is Gates. Bill has put a small amount of money into water and sanitation projects, but the main thrust of his spending is on vaccines. He even boasts about this.

His wife has talked abut how much we can learn from Coca Cola, because they have a distribution system for their destructive product. I know Coca Cola like to wave their products about in famine and drought areas, but people don't need bottled water, which wastes far more water than it produces. They need a sustainable supply of clean water, unlike what those living in Kerala and other parts of India experienced when they happened to be close to a Coke factory.

Myths are not exclusive to poor, undereducated people suffering from bad health. The sort of myths emanating from Gates (the people and the foundation) are far more harmful, because the media, that great purveyor of myths, blasts them around the world, and so many powerful people seem anxious to repeat myths from the powerful Gateses.

Drugs, scientific breakthroughs, technology and things that the likes of Gates are interested in are not a priority; clean water and sanitation, along with basic health and education are priorities. This is not new, but the message doesn't seem to have reached the literate.

Pre-Exposure Prophylaxis, Till Death Do Us Part

Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from HIV infection. So far, such a use of ARV does not give 100% protection. However, like male circumcision and the use of topical microbicides, it could be used along with condoms. Or you could just use condoms.

But the ultimate aim is to develop PrEP that allows people to have safe sex without using condoms (otherwise they will tempt very few). Cynics even suggest that the aim is to allow men who have sex with men (MSM) in rich countries to have unprotected sex, but I don't quite buy that.

The fact that a lot of the clinical trials are taking place in developing countries doesn't mean the people there will eventually benefit from PrEP. But to the pharmaceutical companies that sell ARVs, developing countries represent a huge potential market. That's as long as donors can be persuaded to pay for the drugs. Costs are far beyond what people or governments in developing countries can afford.

There are many questions to be raised about how much the use of PrEP could really help reduce HIV transmission. But my question is about who, exactly, would be the targets of a PrEP program in developing countries, taking Uganda as an example (because I happen to have the Ugandan Modes of Transmission Survey handy).

You might think an obvious target for PrEP would be sex workers. But in the 2009 survey, Ugandan sex workers were estimated to contribute 0.91% of HIV incidence. If you add in their clients and the partners of their clients, that still only comes to an estimated 10.5%. PrEP rollout for these groups, assuming you could actually round them all up, would be very expensive. But it doesn't look like it would have much impact on the overall epidemic.

The largest single group, contributing 43% of total incidence, consists of mutually monogamous couples engaging in heterosexual sex. Bizarre as it may sound, most HIV in Uganda, a virus that is difficult to transmit sexually, is transmitted by very low risk sex.

Those engaging in multiple partnerships, along with their partners, make up 45% of incidence, so perhaps they would be good targets. Again, it would be a mammoth task to round up such a large number of people, let alone distribute drugs to them all and ensure that most of them took the drugs most of the time for as long as they continue to be sexually active.

Think of it this way, Kenya has several hundred thousand HIV positive people on ARVs, that's less than 1% of the population. Around 99% of that money comes from donors. And even that few hundred thousand people is beyond what the countries health services can manage, despite all the donor funding.

The sad truth is that, either you 'target' much of the sexually active population of Uganda, which is not really targeting, more scattergunning, or you will not have any sizable impact on the epidemic. But PrEP is simply not the sort of intervention that you can roll out to a large sector of your population.

An article about the costs involved in rolling out PrEP in Australia cites very high costs just for basic, first line drugs. At up to and beyond 10,000 dollars per person, for the rest of their life, this will not even be discussed in developing countries. And while the drugs will be available at far lower cost in places like Uganda, you are talking about millions of potential recipients. Resistance to first line drugs may only amount to 3 or 4% (if they are lucky) but you can multiply that five or ten times to calculate the addition to costs.

The drugs will be available at far lower prices because drug companies have an uncanny way of knowing just how much they can squeeze out of a 'marketing' situation. Rich countries will pay hefty sums for worthless drugs, or drugs worth very little but in huge quantities. Just look at Tamiflu and the stockpiles of it. They will pay less to purchase drugs for developing countries, but the quantities will be mind boggling and Western run institutions will agree to any price once it's in the hundreds of dollars, apparently.

Talking of Tamiflu, one of the main proposed PrEP drugs is Tenofovir, discussed in glowing terms and voluminous quantities during the Vienna Aids Conference. Another is called Truvada, a combination drug. Gilead is involved in all three.

Another name that crops up is Bill Gates and his Foundation, who are never far away if there is money to be made out of intellectual property. But what will the benefits of PrEP be? If Modes of Transmission Surveys like the one for Uganda are correct, almost everyone that has sex in high and medium HIV prevalence countries is at risk. They can't all be put on preventive drugs, even if it were possible to afford such an intervention.

It may sound as if I am claiming that an almost entirely useless HIV prevention strategy is being advocated for by the very pharmaceutical industry that stands to gain billions from it. And that's exactly what I am claiming. Big Pharma expect billions more dollars, on top of the billions they have already received, to flow from persuading donors to pay for up to tens of millions of healthy people to be put on drugs for a large part of their life, with little or no benefit and possibly a lot of damage. In a nutshell: pre-exposure prophylaxis or PrEP. Remember the name.

NB: I have set up a new blog to discuss the subject of pre-exposure prophylaxis or PrEP.

Poverty Makes the World Go Round

How do you undermine the rights and autonomy of whole populations and, instead of censure, receive only praise? Simple, you just call it development. A multinational that respects little aside from money, and certainly has no time for democracy, is bad enough. Yet, when it joins forces with an institution with similar qualities, but happens to be an international 'charitable' foundation, there is very little anyone can do to rein in their actions, no matter how exploitative, destructive or manipulative they may be.

The Gates Foundation has been bullying countries into dancing to its tunes for some time now. And Monsanto's monopolistic behavior is legendary. But both these institutions recognise just how far they can go as long as they bleat on about 'helping' people, saving lives, feeding the hungry, etc. How can anyone object to such philanthropic actions, whatever their motivations? They certainly couldn't object to 'donated' food merely on the grounds that it is genetically modified (GM), could they?

Some like to make out that opposition to GM is based on a fear that the foods are damaging to people's health. Perhaps some people do have such fears. And those with an interest in pushing GM do not themselves know what effects the technology could have on health or the environment (or if they do know they have never made their findings public), so they certainly don't want anyone else to know. Because people's fears are based on lack of information, rather than availability of information, the industry can churn out any kind of deceit to defend themselves (or pay pseudo-academics to do it for them).

But others are more worried about the fact that multinationals like Monsanto want to monopolise agricultural production, from the choice of seeds, the varieties of produce, the agricultural inputs, the agricultural practices employed, all the way to what people eat, how much they know about what they eat, how much they pay for it, how food is produced and stored and anything else they can control. They are not just food facists, Monsanto runs the whole gamut of facism.

Couple this with the man who wants to do for food what he succeeded in doing for software and you've got a real threat to democracy, health, the environment, the economy and even global security. If there’s anything about facism Monsanto doesn’t know, Bill Gates and his Foundation will soon fill in the details.

People in developing countries may have been kept in the dark but they are not stupid. They know that there are reasons for high food prices and lack of access to food; they know that the prices are not necessarily high because of shortages and that lack of access to food is not necessarily because of their country's inability to produce it.

There is little secret about the fact that famines, food shortages and food insecurity, including recent instances of these, are not caused by lack of food; many countries experiencing these phenomena have plenty of food. It is obvious to many that it is people with large amounts of money who created prices beyond the means of those living in developing countries. And you don't need to be a genius to know that shortages of (edible) food can be created when most land is used for products destined for the rich; biofuel crops, flowers, luxury fruit and vegetable, tea, coffee, cocoa, rubber, sisal, animal feed (for Western animals) and the like.

One of the financial institutions that did very well out of the recent handouts to the rich, Goldman Sachs, also made a lot out of the food price speculation that created the food crisis a few years ago. They raked in an estimated billion dollars; even by Gates’ standards, that’s a lot. They do very well out of human misery, benefiting from it, as well as causing it. So who would pass up the opportunity to share in their returns? The Gates Foundation certainly wouldn't.

Is it really philanthropy to extract money from people and then give some of it back to them? We don't really know how much the Gates Foundation's ill gotten gains come from the countries that eventually 'benefit' from its 'largesse'. The Foundation, in its great (undemocratic) wisdom, decides who benefits as well as who loses and they are certainly not going to tell members of the public, especially not in developing countries. The Foundation aims to keep its wealth intact, regardless of how it achieves this. Any doubts or worries that arise can be assuaged by some pretty pictures of happy children or mention of names like ‘Kofi Annan’.

It comes as no surprise that the Foundation now has a considerable investment in Monsanto. This multinational has much to gain from developing countries and has shown that it is unscrupulous enough to do whatever is required to maximize its gains. The Foundation's sham 'Alliance for a Green Revolution in Africa' (AGRA) has never denied that it will take advantage of GM if and when it sees the benefits. Gates has been investing in Monsanto for years. Some have probably been wondering when pay day was due.

This diabolical coupling does have one feature that may not be completely negative: it brings into clear focus the intimate connection between the unscrupulous grabbing by some institutions and the equally unscrupulous ‘philanthropy’ of others. Gates and a small handful of other rich people and institutions control the means of production where the products include poverty, disease, starvation, environmental destruction and a whole lot of other ills. And where would we be without all of them?

Pills For Poverty

An article in SciDev.net entitled Don't Medicalize Micronutrient Deficiency argues that biofortifying foods or handing out food supplements is not a sustainable solution to malnutrition problems. Countries that have high levels of malnutrition have food and agriculture problems that pills or fortified foods will not solve.

This is a timely reminder, when so many 'solutions' come in the form of technical fixes that are often expensive, short term, inappropriate, unsustainable and often don't even work. I recently mentioned Bill Gates efforts to eradicate water borne diseases like polio, malaria and cholera by developing vaccines when the best strategy would be to improve water and sanitation. Water borne diseases can not be eradicated in areas where people don't have access to clean water and adequate sanitation.

Another problem with certain biofortified foods is that they have intellectual property rights associated with them, which adds a lot to their cost. Why should poor people suffering from nutritional deficiencies, instead of being enabled to produce enough high quality food, be offered something that is expensive and is just impoverishing their country further?

Some of the manufacturers of genetically modified organisms (GMO) have even got in on the micronutrient method of screwing yet more money out of developing countries. The vitamin A fortified rice, which was claimed to reduce blindness caused by vitamin A deficiency, springs to mind. Unfortunately, it contained vitamin A in a form that could not be absorbed and so it was a useless technology.

Poverty is the real problem when people can't afford a balanced diet for their family. If they are poor, they are certainly not going to be able to afford with the sort of premium price that intellectual property brings. And we have seen enough instances of poverty, disease and malnutrition being used as vehicles to sell expensive Western technologies, especially dangerous technologies that impoverish people further and that could even damage their health.

The attitude of multinationals, and that of certain people, seems to be to let people become sick and then come running with the pills or the GMOs or the technical solution. People need adequate economic means, food, food security, education, health services, water, sanitation, housing and the rest. In the absence of these human rights, they will suffer and die prematurely.

It may be the prerogative of multinationals and others to allow people to live in inhuman conditions as long as they can sell plenty of their goods. But it is not the prerogative of those who work in development or those who work to keep in check the excesses of multinationals. As the article in question points out, many of the people in the world suffering from malnutrition are farmers. They should be allowed to produce food that can provide themselves, their families and their countrypeople with a balanced diet. This would also improve economic circumstances and therefore health, education and other things, too.

If someone prescribes pills as a substitute for clean water or good food, they are probably a multinational.

Philanthropic Tokenism

Apparently Zanzibar succeeded in eradicating malaria in the 1970s, but it returned. Now they are about to eradicate it again, or at least, rates are far lower than they have been for a long time. However, there seems little chance that they will succeed in keeping malaria down for good.

Zanzibar, like many places in Africa, has problems with garbage disposal, sewage disposal, water, hygiene, infrastructure, especially roads and electricity, education, housing, poverty, health and many other things. These are the conditions in which a disease like malaria thrives. It is fairly certain that unless Zanzibar tackles these problems, malaria and other deadly (though preventable and curable) diseases will continue to be endemic.

The world was told that polio had been all but eradicated in the last few years and in a short time there would be no further cases. But polio has returned, partly because of a boycott on vaccinations in Nigeria due to rumours about their safety. As a result, there is talk of changing the polio eradication campaign from its present 'vertical' strategy to a more 'horizontal' strategy.

A vertical approach takes one disease and aims to vaccinate everyone who may be infected and, if possible, treat those who are already infected. A horizontal approach aims to provide health services for everyone and sees all diseases as being in need of prevention and/or treatment.

Realization that vertical approaches are not working and that horizontal approaches don't carry the kudos of being able to eradicate a whole disease gave rise to talk about health system strengthening and even 'diagonal' approaches, that would combine the horizontal and the vertical. Unfortunately, much of this has remained just talk.

There is even talk of Bill Gates taking a less vertical approach to polio eradication or risk seeing hundreds of millions go to waste. But I find that hard to believe. I don't think Gates lacks understanding of why polio (and other diseases) elude single disease approaches that involve some kind of expensive, technical fix. All he has to ask himself is why people are being infected by a disease that is spread through human feces. To put it another way, why are people drinking contaminated water?

Gates is fond of talking about water and sanitation but most of his money goes into things like vaccines. Indeed, much of it goes into US institutions and US citizens working on vaccines. Very few broad-based water and sanitation programmes, aimed at preventing all water borne diseases, are being financed by Gates.

Gates can spend his money and fail to eradicate polio or cholera or malaria or any of the diseases that he wants to be associated with eradicating. But as long as the water is contaminated, all his programmes will fail. As for his ideas on how to make the polio programme more 'diagonal', all that's mentioned is "training for health workers on topics such as hygiene and sanitation". Hygiene and sanitation are not just things people need to know about, they are things people need access to. It's no use health workers telling people to wash their hands and dispose of their faecal waste properly when they don't have clean, running water and adequate sewage disposal systems.

Maybe Gates will get involved in genuine 'health system strengthening', but just paying a few professionals more to work in his funded institutions is not going to help. That has just increased the brain drain from indigenous health institutions and taken attention away from health in general to concentrate on his favourites. But it seems more likely that he will continue to do what he is doing and put even more money into spin. After all, he has his agenda and evidence from the field has never affected that.

Diseases are not trophies and global health is not a matter of having a wall covered in certificates for attempting to eradicate a small number, or even a large number. Health depends on other crucial rights, such as food food and food security, water and sanitation, adequate living conditions and good education. Without these, throwing money at a handful of diseases will have little impact. Maybe some disease will be wiped out, or as good as, but people will continue to die of other preventable and curable diseases. Gates should work for human rights, any human rights or even all human rights. Instead, he's just wasting his money on philanthropic tokenism.

Bill Gates to Face Trial by Intestinal Worms

It has long been recognized that poor health results in people being more susceptible to anything going. That's why many people aim for good overall health by watching what they eat, taking enough exercise, getting enough sleep, etc.

It was also established some time ago that poor health and a high disease burden results in populations being more susceptible to major diseases like cholera, malaria, acute respiratory infections, TB, HIV and many other things.

The connection between high rates of intestinal parasite infestation and HIV was made more than a decade ago and soon after, it was pointed out that the search for a HIV vaccine would be hampered by the high disease burden suffered by populations most affected by HIV.

Anyone seeing a connection yet? People in areas with high rates of HIV are the same people who suffer from numerous diseases, many of which are treatable or curable, they suffer from poor water and sanitation supplies, poor nutrition, etc. Oh, and low levels of education, minimal infrastructure and many other things.

On the other hand, if water and sanitation were improved, many of the most common diseases would be prevented or seriously reduced. Cholera, for a start, also intestinal parasites, also hepatitis E, the list is long. 20% of young people in developing countries die of diarrhea alone, most of the other things that kill young and old are either preventable or curable. Many relate to water and sanitation.

So why does Bill Gates want to find a vaccine for cholera. He seems to like to find a 'big one' and hack away at that. HIV, TB and malaria are three others (the third of which is also directly related to water and sanitation). He wants to create a completely unsustainable and expensive solution to cholera when the best prevention for this is good water and sanitation.

Cholera vaccine research has come up against a problem. The vaccines work well in developed countries, where water and sanitation are not such a problem, but they work badly in countries where water and sanitation are a problem.

Have I spelled it out clearly enough for Bill and his defenders? I'm not saying he shouldn't spend his money on research that could save the lives of millions of people. I'm suggesting that he could spend his money on saving the lives of billions of people. Think of the number of diseases that would be reduced if he spent his money on water and sanitation.

But he seems to like intellectual property, drugs for cholera, drugs for malaria, drugs for HIV, drugs to prevent HIV among those who are not yet infected, pharmaceutical products for the starving, in the form of genetically modified organisms, a 'green revolution' driven by locking poor famers into an agreement to be slaves for the biggest multinationals in the world.

Because Bill knows intellectual property, he made his money out of it. What is software but intellectual property, low costs but high sale price? He has been manipulating intellectual property for most of his working life and now that he has become a philanthropist, he is depending on it still.

I'm not suggesting that he has anything personal to gain, in the sense that he has shares in all these pharmaceutical companies and all the others that will make billions. Perhaps he doesn’t have shares or any kind of interest. I'm just suggesting that there are immediate things that could be done that would obviate the need for all this research into more drugs when the solution is far more basic.

People in developing countries need, in addition to water and sanitation, good education, access to health care, good nutrition and food security, infrastructure, rights, equality. Drugs come and go, that's the problem, that's one of the reasons that they are not sustainable (also the ridiculously high prices and the corruption that keeps the prices high). And why put so much money into this technology when there are solutions that will have far greater benefits?

As many as 2 billion people in the world may have intestinal worms, this will affect their health, their welfare, their intellectual and physical growth. Bill, think of what good water and sanitation could do for people, never mind the pharmaceutical companies. Beating the worms would be a far bigger reward.

Intellectual Oppression

If you were a subsistence farmer in Kenya and you were in desperate need of money, would you consider mortgaging your future? After all, if you don't risk your future, you may not even have one.

Here's what you can do:

The Rockerfeller Foundation and the Bill and Melinda Gates Foundation think that the 'Green Revolution' in other developing countries was so good, they want to see another one and this time they want it to include Kenya and other African countries. Never mind that countries who experienced the first green revolution now realise what a terrible mistake it was.

These philanthropic parties are spending millions of dollars to ensure that poor farmers can purchase genetically modified (GB) seeds so that they can plant a green revolution in their own fields.

Don't get caught up in the argument about how GM crops could damage your health. People who oppose those arguments only want to catch you out by asking what evidence there is for health risks. Of course, there may be health risks, GM organisms have not been shown to be safe for human consumption. But that is not even the most important concern about GM.

If you buy GM seeds, you must buy the appropriate herbicides, pesticides and fertilizers to ensure the 'benefits' promised by the manufacturers. Yes, they manufacture the seeds, the pesticides, the fertilizers and the stories about how GM is good for your health, the environment and just about everything else.

In fact Agra (Alliance for a Green Revolution in Africa) also claim to be aiming specifically at small farmers. GM crops and 'improved' agricultural methods are primarily aimed at big farmers, but hey, what's a little white lie here and there?

The only people that stand to benefit from GM are the manufacturers of GM products. Oh, and those who have a financial interest in GM companies. Maybe these esteemed philanthropic parties have such a financial interest, maybe they don't. But it's big, powerful, rich people and companies that make a lot of money; you, I and small farmers only stand to lose. By the time said parties have made themselves even richer, most land will be depleted and contaminated, it will lack diversity, it will be as far from organic as it can possibly be and we will find it very difficult to reverse what they have got us into.

Farms surrounding those growing GM crops will also be contaminated. This contamination will come from cross pollination and run-off that carries toxic substances to other farms and into the water supply. Farmers who buy into GM are not just mortgaging their own future, they also mortgage the futures of their neighbours.

Does it sound dramatic to say 'mortgage your future'? Well, if you are a farmer, you are probably used to the process of growing crops and taking advantage of the way you can keep some seed each year. This can be used to grow the next years crops and you can even be selective, to preserve the best qualities in your crops.

Sorry, but you are not permitted to collect seed and grow more GM crops next year. Some GM crops are not even appropriate for this process. You will owe the GM manufacturer money because the seeds are a piece of intellectual property, you must pay for it. Even your neighbours could be found guilty of infringing GM companies’ copyright, even though they didn't take the king's ransom!

Ok, you can, slowly, get rid of some of the GM contamination. You can start afresh, growing wholesome non-GM crops. Well, maybe you can. You will already have played a part in reducing the biodiversity on your land and on surrounding lands. In fact, herbicides and pesticides used on GM crops kill everything, plant and animal, but that GM crop. This is one of the things that GM producers like to boast about.

But if you replace the GM soya with non-GM soya because you find it is not as productive as it says on the packet, you may be in for a nasty surprise. If the 'non-GM' crop is found to contain some of the GM manufacturer's intellectual property you are still liable to pay for it. Which is fantastic…if you’re a GM company.

The Rockerfeller and Gates Foundations may well do some great work, they may well fund many laudable projects but that shouldn't stop people from scrutinising what they fund. GM crops are not in any sense laudable and the fact that so much money is being spent on trying to get people to grow them should sound alarm bells.

As a rule of thumb, where intellectual property is involved, the interests of the rich are being served. If someone tries to tell you that poor people will benefit, check their credentials very carefully.

This is another example of Development by Omission, where developing countries would be a lot better off if they didn't receive this 'donation' from the rich and powerful. It's a lot more subtle, but also far more damaging than stealing maize intended for starving Kenyans. And it's not even considered to be a crime. Not yet, anyhow.