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In South Africa, Using Mobile Technology to Improve Maternal Health Access

Fri, 10 May 2013 10:10:00 EDT

MAMA users in South Africa receive daily text messages filled with tips and reminders about the health of their babies. Photo by Imani M. Cheers/IRP.

Memory Banda is busy. Her 10-month old son is teething and taking his first steps around her Hillbrow home, a revitalized neighborhood in Johannesburg's bustling city center.

"This is my first child so I didn't know what to do when his teeth started to show," she said. When Memory needed tips and advice about her son's teething process, she didn't need to go to her local clinic or call a doctor. Instead, she receives several text messages a week about her baby's development from the Mobile Alliance for Maternal Action, affectionately known as MAMA -- a global movement that uses mobile technologies to improve the health and lives of mothers in developing nations.

According to UNICEF, 4,300 mothers die in South Africa every year due to complications of pregnancy and childbirth, 20,000 babies are stillborn and another 23,000 die in their first month of life. In total, 75,000 children do not make it to their fifth birthday.

South African women living in poverty face many challenges, specifically access to quality health care. In communities such as Hillbrow, there are high rates of unemployment, poverty and HIV prevalence is estimated at 30 percent among pregnant women. Despite these challenges, mobile technologies are providing women with access to life-saving maternal health information.

MAMA provides pregnant women and new mothers with vital information and support using their mobile phones, through five different channels, including an interactive website, text messages, social networking and voicemails. Women are charged one rand (about 10 cents) to sign up for the MAMA services.

MAMA Mobi -- the group's interactive website -- is also available to users with smartphone capabilities. Information based on specifics such as their baby's due date or age milestones are personalized for each user. MAMA SMS sends text messages and reminders to women in five different languages, including English, Zulu, Xhosa and Afrikaans. MAMA Voice sends pre-recorded messages in the same languages as the text messages for users who face literacy challenges.

MAMA MXit takes advantage of the 10 million-plus users on MXit, a social networking site, and has established an educational portal for South African men and women between the ages of 18 to 25 years old with important information about pregnancy, childbirth and parenting.

MAMA South Africa faces many challenges, including literacy rates among users and he high cost of text messages. As a result of the high cost, MAMA is not currently offering nationwide text-based reminders, but the goal is to offer this to moms on a national basis in the near future. The text service will consist of a weekly message reminder from five weeks of pregnancy until a child is one year old.

In addition to encouraging and empowering mothers with stage-based health information, MAMA's mobile messages provide reminders for mothers to go to the clinic. For mothers living with HIV, MAMA provides messages on the importance of taking ARV (antiretroviral), breastfeeding, and getting their baby tested for HIV.

MAMA South Africa is ending the pilot phase of the program and working on gearing up to increase the scale and reach of the mobile service with a goal of reaching 500,000 mothers by 2015.

This story is part of a series of reports on the impact of mobile technology and health in 10 African countries. For more, visit The Cheers Report.

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In Senegal, a Campaign of Education and Dialogue on a Painful Rite of Passage

Thu, 09 May 2013 18:37:00 EDT

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JEFFREY BROWN: Next: abandoning a widespread and painful rite of passage.

Special correspondent Fred de Sam Lazaro visited the West African nation of Senegal. His report is part of our Agents for Change series.

And a note: Some viewers may find the subject matter troubling.

FRED DE SAM LAZARO: As dusk approaches, a group called Tostan sets up a giant screen in this remote village in Senegal. To overcome language barriers, the feature will be a 1929 Buster Keaton silent film. The film is a hit, as were events put on earlier in the day by Tostan.

Its mission is to teach about human rights, specifically the right to health, but its seminars and skits will often lead to a discussion of an age-old custom: female genital cutting.

WOMAN: She needs to be cut. All girls need that. You can't have a recognized marriage if she's not cut.

FRED DE SAM LAZARO: This painful rite of passage is practiced by both Muslims and Christians across a swathe of mostly African nations, from Senegal to Egypt.

Each year, the World Health Organization says up to three million girls in Africa are subjected to genital mutilation, and up to 140 million women live with its consequences. Genital cutting probably originated in the harems of ancient rulers as a means of controlling women's fidelity, or a sign of chastity among those who aspired to be consorts, according to Molly Melching, who started Tostan.

MOLLY MELCHING, Founder, Tostan: As the years went on, I mean, 2,220 years, it became very much a part of what was considered criteria for good marriage.

FRED DE SAM LAZARO: Melching is an Illinois native who has lived here for about four decades, first as a student, then a Peace Corps worker.

Genital cutting was rarely discussed publicly, and in fact when she began Tostan 20 years ago, her goal wasn't to end it, but instead to simply provide information that was sorely lacking.

MOLLY MELCHING: When you see a friend that you've known for several months and you've gone to her house for lunch, and then she tells you her child has some problem, that it's someone who has cast an evil spell on the child, the baby, and that she's going to take them to a religious leader to get the spell taken off, and you don't know what to say, and it turns out the baby was dehydrated.

FRED DE SAM LAZARO: But the more Tostan's staff and volunteers talked to local communities about health, the more the topic Melching calls FGC came up, since people began to tie it to bad health.

MOLLY MELCHING: So, suddenly, as they started learning germ transmission and the consequences of FGC and how these infections occur and why they had more problems in childbirth than other women who have not been cut, they started saying, wait a minute.

FRED DE SAM LAZARO: To go from talking about an age-old cultural norm to actually changing it presented a huge challenge. Tostan's approach has been to go to local imams to get their agreement that the ritual is not a religious obligation.

MOLLY MELCHING: We share our modules with the religious leaders, so that they see that everything that we do is for the well-being of the community, the health, and all these things are things that Islam espouses. And so they're very happy in general, but first of all they're happy because we start with them.

FRED DE SAM LAZARO: That respect also carries over into the group's messages in general.

MOLLY MELCHING: Tostan found that using approaches that shame or blame people really was just the opposite of what would work in changing social norms.

When you say to someone, we know you love your daughter and you're doing things because you love your daughter, but let's look at this and let's try to understand together exactly what are the consequences of this practice, but you are the ones that will have to make the decision, then suddenly people are willing to listen. They don't get defensive.

FRED DE SAM LAZARO: It's been far more effective than the approach of many aid groups, says University of California, San Diego, Professor Gerry Mackie.

GERRY MACKIE, University of California, San Diego: When we think of an ideal way of making a change, we'd say it's democratic. We all get together and talk it over and decide what the best thing is to do, whereas some development approaches would, say, force them to do it, pay them to do it, trick them into doing it.

FRED DE SAM LAZARO: In Tostan's approach, local leaders and elders produce the skits and lead discussions. Their words and personal experience carry strong credibility.

Diarre Ba used to make a living as a cutter.

DIARRE BA, Senegal: I was part of this process. I felt bad. This is not right. But I didn't know anything at the time. I had no learning.

MARIAM BAMBA, Senegal: It's painful. I can never forget the pain, so painful.

FRED DE SAM LAZARO: Mariam Bamba is a longtime campaigner for Tostan, and she spared her 10-year-old daughter the trauma. Yet, early in her own marriage, she was determined to keep up the tradition, even though her own husband was opposed to it.

SULEYMAN TRAORE, Senegal: She insisted that she had to do it. There were so many problems if you didn't do it. If you cooked meals, no one would eat your food. It's because we didn't know.

People told us that it was our religion. If you don't do it, you'll be going against your religion. All this is false. But I alone can't do this in the village.

FRED DE SAM LAZARO: Doing this alone could render one's daughters unmarriageable.

So one of Tostan's most critical roles today is to lessen the stigma by getting whole communities and others into which they might marry to jointly declare an end to cutting. Public rallies called declarations have increased to include hundreds of villages who gather to celebrate the decision.

GERRY MACKIE: One part of bringing about a change like this is to get everyone to change at once, what we call coordinated abandonment. Everyone has to see that everyone else sees that everyone is changing.

MOLLY MELCHING: Never in my wildest dreams could I have imagined that I would be sitting here years later, saying that 4,792 communities in Senegal had abandoned. In the beginning, it was just unthought of, unbelievable, because it was so taboo.

FRED DE SAM LAZARO: Since our visit, the number of communities has grown to more than 5,000, and many have also pledged to change another tradition, the frequent practice of allowing older men to marry adolescent girls, acknowledging both the health risks and the girls' human rights.

Molly Melching says there are examples in history of this kind of sweeping shift in social norms and attitudes. She sees a very current one every time she comes home in American views on smoking.

MOLLY MELCHING: People were smoking, and nobody said anything about it much through the '50s, the '60s, and even the '70s. And as people became more and more aware of the harm that it causes, more and more people -- there was a critical mass of people who started really protesting. It was amazing for me, coming from Senegal to the United States, to see how quickly things turned around.

FRED DE SAM LAZARO: Tostan's efforts have now expanded beyond Senegal to seven other African nations.

JUDY WOODRUFF: A version of Fred's story aired on the PBS program "Religion & Ethics Newsweekly."

His reporting is a partnership with the Under-Told Stories Project at Saint Mary's University in Minnesota. He talks more with Molly Melching on our World page. Find their conversation about how she got her start in activism against genital mutilation.

Preventing Drug Shortages with Cell Phones in Malawi

Wed, 08 May 2013 11:06:00 EDT

Eighty percent of the 13 million Malawians live in rural areas, making delivering health services challenging, especially in remote parts with no roads. Photo courtesy of JSI/cStock.

BALAKA, Malawi -- Ishmael Katanga's clinic is a small, two-room mud hut in southern Malawi that serves approximately 3,000 local residents. He sees roughly 15-20 patients per day, usually children under 5 years old suffering from malnutrition, malaria, dehydration and diarrhea. In treating these preventable diseases, one of Katanga's biggest setbacks is access to medication and supplies.

Often, he has to turn patients away or encourage them to come back at a later time to receive their necessary medication. This scenario is common in rural clinics, where supplies and medications are scarce, causing what is known as a "stock out."

Health Surveillance Assistants (HSAs) receive training on the cStock system.

That's why the Malawi Ministry of Health (MOH), in partnership with public health research organizations such as John Snow, Inc. (JSI), has developed a mobile health program called cStock. It's part of a larger project with the goal of finding affordable, simple and sustainable supply chain solutions that address the unique challenges of community health workers.

cStock is a mobile text message-based reporting and web-based resupply system currently being used by more than 1,000 community health workers -- commonly known as health surveillance assistants (HSAs) -- for monitoring and managing community-level essential medicines and commodities for child health, family planning and HIV testing. In a 2010 Ministry of Health assessment, only 27 percent of HSAs had all the medicines they needed to treat pneumonia, diarrhea and malaria in stock on the day officials visited. HSAs live in the villages and are available day and night for patients to bring sick children to be treated quickly.

The mobile system allows HSAs to transmit information regarding their supply of 19 essential medicines to their local health center. The system is called cStock because it literally allows district and central level staff to "see" what medications and supplies are in stock at the community level. This transparency streamlines the needs of HSAs to their local health center, hopefully preventing future "stock outs" and improving relevant supply chains.

By using mobile technology, health care workers such as Katanga are able to text their medication and supply needs to health centers on a bi-weekly schedule. "I used to turn patients away because I didn't have the proper medication to treat even the simplest case of diarrhea," Katanga said while visiting his small clinic. "Now that I've been trained to use cStock, I am hopeful that I won't have to turn away the children and I can better serve my community."

cStock is part of The Supply Chains for Community Case Management Project (SC4CCM), which is a five-year project aimed at identifying, testing and implementing interventions in supply chain management in three countries: Malawi, Rwanda and Ethiopia. SC4CCM has also trained more than 45 data collectors to use Java-enabled mobile phones equipped with data collection software to conduct assessments of community case management supply chains.

While cStock is improving access to medication and supplies on the rural and health center level, there are still challenges. Clinics are understaffed and overcrowded and electricity is not reliable, making it difficult for community health workers to have a steady and consistent charge on their phones.

But officials say these challenges are being addressed at the Ministry of Health level as qualified health workers are being trained and electrical infrastructure is a priority nationwide.

Katanga, for one, is grateful for his training, particularly given that one of his recent patients was his own son. "I ran out of rehydration salts last week but was able to get a new batch of medication yesterday," he said.

This story is part of a series of reports on the impact of mobile technology and health in 10 African countries. For more, visit The Cheers Report.

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Best and Worst Countries for Babies on Their First Day of Life

Tue, 07 May 2013 00:01:00 EDT

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One million babies die each year on the day they are born, according to a new study released by the international nonprofit Save the Children. In their annual "State of the World's Mothers" report, the organization examines global newborn day-of-death data, and ranks 186 countries based on where babies have the best shot at surviving their first day of life.

A baby born today in Somalia (at the bottom of the list) is 43 times more likely to die on her first day than a baby born in Luxembourg (at the top of the list). The U.S. ranked 68th on the list with 11,300 babies dying the day they were born in 2011.

Save the Children President and CEO Carolyn Miles in India in 2013.

The report points out that overall mortality rates for children 5 and under have dropped dramatically since 1990, from 12 million to less than 7 million deaths a year. But newborn health hasn't received the attention it deserves, according to Save the Children President and CEO Carolyn Miles. "In the developing world, a baby's first day is the most dangerous day of life," Miles said. "When you look at childhood survival, we've made tremendous progress. But if we want to get to zero preventable deaths, we have to address the newborn piece."

Miles spoke with the NewsHour after returning from a recent trip to India, where more than 300,000 babies die on their birth day -- the most of any country in the world.

"I met a mother in one of Delhi's largest slums who had recently given birth to her fourth child, a little girl," Miles said. "She gave birth in her tiny home with a traditional birth attendant who didn't know what to do when the baby wasn't breathing. They tried rubbing and slapping her, but she died an hour after birth. If the mother had gotten to the hospital, that baby would have lived because they had basic resuscitation devices."

A baby in Nepal after application of CHX to her umbilical stump. Photo courtesy of Save the Children.

In fact, the report highlights four low-cost medical products, including resuscitation devices, which Save the Children says could save one million newborns a year.

The other tools include antenatal steroid injections to delay preterm labor, antiseptic chlorhexidine (CHX) to prevent umbilical cord infections, and injectable antibiotics to treat infections.

The report also ranks the best and worst countries to be a mother based on five indicators: education, income, women's political representation and the chances a mother and her baby will survive.

Save the Children is enlisting the help of several celebrity moms, including Jennifer Garner and Jennifer Connelly, to raise awareness and financial support for newborns and their mothers around the world. They recently released this YouTube video titled "First Moments."

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Maternal Health Hotline Helps Malawians Stay Connected

Fri, 26 Apr 2013 16:18:00 EDT

Doreen Namasala has been a community health worker for over a decade in rural Malawi, a small landlocked country in southeast Africa. With a population of roughly 15 million, an estimated 60 percent of women report having serious problems accessing health care due to distance, according to the country's ministry of health.

Too often, Malawi's health care centers, hospitals and clinics are overcrowded and understaffed, resulting in an overburdened health system that lacks the resources to effectively treat patients.

But as mobile technology skyrockets across the African continent -- with mobile phone subscriptions growing 20 percent a year over the past five years -- the Malawi Ministry of Health and NGOs such as Village Reach are collaborating with communities to use cell phones to address some of the causes of poor health care for women and children. Problems include limited availability of timely and reliable health information, access and use of health facilities and delays in services.

Namasala started working at the "health center by phone" or chipatala cha pa foni in local Chichewa a year ago, answering about 15 to 18 calls per day. Chipatala cha pa foni aims to improve maternal, newborn and child health services and increase community confidence in the health system.

Currently the pilot project has four key components:

A toll-free case management hotline

An automated and personalized service offering tips and reminders for pregnant women and caregivers of children under five

A health center booking and appointment center

Community outreach and education on maternal, newborn and child health issues

The program has seen signs of success, including receiving 400-600 calls per month, with over 75 percent of callers interested in receiving advice and/or registering for tips and reminders.

However, there are still many factor hindering progress. Phone ownership is low -- less than 25 percent -- in rural areas, making it necessary for patients to rely on community health workers' phones to access the hotline and receive tips and messages. Telecom services and "talk time," or cell phone minutes, are also expensive for Malawians, which deters patients from utilizing the service.

Despite these setbacks, integrating technology into Malawi's health system is largely perceived as a success. After all, even an expensive lifeline is one that many Malawians didn't have before.

This story is a series of reports on the impact of mobile technology and health in 10 African countries. For more stories go to the Cheers Report. Additional footage for the video above was provided by Concern Worldwide.

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How Cell Phones Are Helping Fight Malaria

Thu, 25 Apr 2013 10:42:00 EDT

Community health workers receive new cell phones as incentives to continue their malaria rapid reporting. Photo by Imani Cheers/PBS NewsHour.

LIVINGSTONE, Zambia --Tokozile Ngwenya-Kangombe, a project coordinator with Akros Research, knows first-hand how dangerous malaria can be for pregnant women and children under the age of five. Roughly half of the world's population is at risk of contracting malaria and more than 200 million people are infected annually, according to the Malaria Control and Evaluation Partnership in Africa.

UNICEF estimates that in Zambia, malaria accounts for 20 percent of maternal deaths and that of all people who die from the preventable disease, 50 percent or more are children under the age of 5.

Malaria is a disease caused by a parasite and spread by mosquitoes. Zambia is home to the deadliest form of the parasite: Plasmodium falciparum and malaria affects more than 4 million Zambians annually and results in almost 8,000 deaths per year.

Ngwenya-Kangombe once traveled upwards of 100 miles per day to reach community health volunteers in southern Zambia's heavily impacted areas. She would spend several hours copying health volunteers and clinic staff notebooks documenting malaria trends. Now, with the use of mobile technology, Ngwenya-Kangombe and health workers have been able to double the number of clinics and patients they visit per day.

At the Siakasipa Clinic located approximately 30 miles from the famous Victoria Falls in southern Zambia, head Nurse Ruth Nghlove serves approximately 8,000 local residents. During the rainy season (November to April) malaria cases are higher than during the dry season (May to October) as the mosquitoes breed in water.

Several key interventions have been implemented since 2000, including distributing long-lasting insecticide-treated bed nets, indoor residual spraying and antimalarial medicines to curb the disease. The introduction of rapid reporting systems, using mobile phones to provide real-time data and the detection of high-infection areas, has health workers and volunteers excited about ending malaria deaths for good.

"With my mobile phone, I can get updates from health care volunteers while they are out in the field instead of waiting hours, sometimes days, for them to make it back here to the clinic with their reports" said Nghlove.

Community health volunteers are not paid a salary in Zambia. Instead, the Ministry of Health and partnering NGOs, such as PATH supply them with incentives including mobile phones and bicycles for their time and efforts. Even so, some health care volunteers are still in need of "talk time" -- or cell phone minutes -- to continue their work.

"I am grateful for the free phone but without talk time, I cannot afford to send in my reports electronically," remarked one community health volunteer, Anna.

Others, such as Kdnele, who has been a community health volunteer for 18 years, is grateful for his phone and bike. "I'm able to visit 6 to 8 patients instead of 3 to 4 with my bike, and I didn't have a mobile phone until I was given one to file my reports," he said.

PATH, in partnership with the Republic of Zambia Ministry of Health, has developed a three-step approach to eradicate malaria, including rapid reporting, mass testing and treatment and active surveillance. These steps are being implemented in Zambia on the pilot level with the goal of creating "malaria-free" zones which will then be duplicated in other sub-Saharan African countries.

On April 25, the global malaria community will commemorate World Malaria Day under the theme, "Invest in the Future: Defeat Malaria," aiming to reach the 2015 Millennium Development Goals and defeat malaria. While many developing countries have an uphill battle ahead, Zambia has found that embracing mobile technology is making those goals as realistic as sending a text message.

For a social media display of community health workers and volunteers, click here.

This story is part of a series of reports on the impact of mobile technology and health in 10 African countries. For more, visit The Cheers Report.

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'The World Needs You, Badly,' Edward O. Wilson Tells Young Scientists

Tue, 26 Mar 2013 12:07:00 EDT

Biologist Edward O. Wilson studies fire ants at Harvard University on Sept. 8, 1975. Photo by Hugh Patrick Brown/Time & Life Pictures/Getty Images.

Edward O. Wilson's "Letters to a Young Scientist" arrived in the mail this week. Finding myself with a free minute, I picked it up and began reading it, and found myself immersed.

We learn a great many things about Wilson himself in this book: that as a teenager he wrestled and caught venomous snakes with his bare hands, that his great-great grandfather was a horse thief, that he first learned calculus as a 32-year-old tenured professor at Harvard.

A deliberate play on Rainer Maria Rilke's "Letters to a Young Poet" -- he compares poetry and science more than once -- this is teeming with advice for a young researcher, ranging from how theories are made and how to choose your field of research to how to build a butterfly net.

It's a book about finding your passion for science and following it faithfully. About finding a discipline that you can call your own -- preferably one that is sparsely inhabited, he says. "Be prepared mentally for some amount of chaos and failure," he writes. "Daydream a lot."

Mathematical skill is not essential, and neither is a genius IQ, he says. Of more importance is creativity, deep thinking, confidence, commitment and allegiance to the small, informal experiments.

He sums up elements of the book in this TED talk:

An excerpt from that speech:

"I found out that in science and all its applications, what is crucial is not that technical ability but it is imagination in all of its applications. The ability to form concepts with images of entities and processes pictured by intuition. I found out that advances in science rarely come upstream from the ability to stand at a blackboard and conjure images from unfolding mathematical proposition and equations. They are instead the product of downstream imagination leading to hard work, during which mathematical reasoning may or may not prove to be relevant. Ideas emerge when a part of the real or imagined world is studied for its own sake. Of foremost importance is a thorough, well organized knowledge of all that is known of the relevant entities and processes that might be involved in that domain you propose to enter."

QUICK BITES

Strange reaction after learning that the person behind a popular science site on Facebook is a woman.

From AsapSCIENCE: Can the snooze button do more damage than good? A look at what it does to the body's chemical processes.

How changing the color of a mosquito's eyes can bode well for stopping the spread of diseases like dengue fever.

Sir Tim Berners-Lee who invented the world wide web, Marc Andreesen who made the first popular browser and three others -- Robert Kahn, Vinton Cerf and Louis Pouzin -- who invented the precursor to the Internet have won the 1 million pound Queen Elizabeth Prize for engineering. "The internet is the most complex engineering feat ever attempted," said the judge. Financial Times reports.

Some science humor:

Two guys walk into a bar. First guy says I'll have a glass of h2o. Second guy says I'll have a glass of h2o, too. Second guy dies. #science
— Jeff Arrrrgh (@ThatMcAliasGuy) March 25, 2013

From NBC News: "After a week of down time due to a computer glitch, NASA's Mars Curiosity rover is once again sending back pictures of its rocky Red Planet locale at Yellowknife Bay."

NOT SAFE FOR LUNCH

This newly discovered amphibian feeds her own skin to her offspring.

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News Wrap: British Food Safety Office Orders Testing After Horse Meat Revelation

Fri, 08 Feb 2013 18:09:00 EDT

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HARI SREENIVASAN: Heavily armed police moved deeper into the snow-covered mountains east of Los Angeles today, hunting an ex-police officer wanted for three murders. Christopher Dorner's burning truck was found yesterday near the Big Bear Lake Resort, about 80 miles from Los Angeles.

Today, San Bernardino County Sheriff John McMahon said, so far, there's been no sign of Dorner himself.

SHERIFF JOHN MCMAHON, San Bernardino County, Calif.: We saw the tracks, as I indicated last night. We followed those tracks around through the forest. We haven't found any new information to suggest the tracks are going to any specific area.

We're going to continue searching until either we discover that he left the mountain or we find him, one of the two.

HARI SREENIVASAN: Dorner was fired from the L.A. Police Department in 2008. This week, he left an angry manifesto on Facebook, in effect declaring war on the police.

At least 36 people were killed in Iraq today in the worst attacks since November. Nearly 100 others were wounded. Car bombings hit two outdoor markets in Baghdad and in the Hillah Province to the south. A taxi stand in Karbala was also targeted. All three were in primarily Shiite areas. Amid the violence, thousands of Sunnis protested against Shiite Prime Minister Nouri al-Maliki.

In Tunisia, huge crowds of mourners protested as opposition leader Chokri Belaid was laid to rest. He was assassinated earlier this week. Tens of thousands converged on the cemetery, with Belaid's coffin draped in a Tunisian flag. Violence erupted as police fired tear gas and demonstrators threw stones and set cars ablaze.

Thousands of demonstrators turned out in Cairo and other cities across Egypt, protesting President Mohammed Morsi and his Islamist-led government. The crowds defied hard-line Muslim clerics, who called on their supporters to kill opposition leaders. As night fell, security forces used tear gas to disperse protesters, who threw rocks and fire bombs at the presidential palace.

Gunmen in Nigeria have killed at least nine women working to immunize children against the polio virus. The attacks today were in Kano, in the African nation's Muslim north. The killers were believed to come from Boko Haram, a radical Islamic sect. Polio remains endemic in Nigeria, but some Muslim clerics have charged the vaccinations are a plot to sterilize young girls.

The British government today condemned the growing discoveries of horsemeat in what was supposed to be imported beef. Officials said they now suspect criminals are involved.

We have a report from Chris Choi of Independent Television News.

CHRIS CHOI: Some of Britain's biggest brands are on the hook as this meat scandal grows. Now government has ordered thousands of beef products be tested, as companies recall ready meals bought by millions. And, tonight, this industry is under pressure.

PRIME MINISTER DAVID CAMERON, Britain: It is about food labeling, proper retailing, proper information. And, frankly, it's also about customers being let down.

CHRIS CHOI: This new wave of scandal started on Saturday. A Luxembourg factory supplying Findus warned them of trouble. DNA tests had started even before that.

But it wasn't until Monday that retailers were told, as Findus then withdrew its frozen beef lasagna. On Tuesday, Tesco and Aldi began to withdraw their products that came from the same supplier. And on Wednesday, tests confirmed horsemeat in Findus lasagna. But there are signs problem could go back months to August last year.

Some shops are only now removing these products, which come from Comigel, a French firm. Information it gave to Findus on Monday is revealed in a letter shown to us. It warns that raw materials delivered since the 1st of August 2012 may not match how they're labeled. In other words, the roots of this alert could go back much further than previously thought.

Crucially, do we yet know who else was supplied by that French factory?

ANDREW RHODES, Food Standards Agency: We're in communication with the French authorities to obtain a list of all the ...

CHRIS CHOI: So you still haven't got a list? You still at this stage haven't got a list?

ANDREW RHODES: Just pause a second.

CHRIS CHOI: No. Have you got a list or not?

ANDREW RHODES: I just -- just a second.

CHRIS CHOI: And after checking, he told me they still have not had a list from the French. Tonight, there are calls for a ban on all meat imports until a clearer picture emerges.

Findus and the French firm Comigel say there is no health risk and they are ensuring this can't happen again. But, tonight, as shoppers fear processed meat is not what is labeled and the ingredient increasingly missing from our food chain is trust.

HARI SREENIVASAN: Horsemeat is considered a delicacy in France and Italy, where it is openly labeled and consumed.

The U.S. Secret Service is investigating the apparent hacking of private e-mails from former Presidents George H.W. Bush and his son, George W. Bush, and other family members. The Smoking Gun website reported today that the hacker known by the alias Guccifer gained access to e-mails, as well as photos, phone numbers and addresses. Another Bush son, former Florida Gov. Jeb Bush, called the hacking outrageous.

Wall Street finished the week on a positive note. The Dow Jones industrial average gained nearly 49 points to close just short of 13,993. The Nasdaq rose more than 28 points to close near 3,194, a 12-year high.

Those are some of the day's major stories -- now back to Judy.

In Haiti, a Mission of Religion and Medicine for Father Rick

Mon, 24 Dec 2012 18:37:00 EDT

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JEFFREY BROWN: Now the story of a Catholic priest's journey as a doctor ministering through 25 years of Haiti's recent history.

Fred De Sam Lazaro has the latest in our Agents for Change series.

A version of this report aired on the PBS program "Religion & Ethics Newsweekly."

FRED DE SAM LAZARO: For 25 years, Father Rick Frechette's mission has been defined and redefined as Haiti has lurched through crisis and even catastrophe.

He came to this impoverished Caribbean nation in 1987 after a few years in Mexico and Honduras to expand the mission of his Catholic religious order.

REV. RICHARD FRECHETTE, Mission Leader: We came in fact to set up what we do everywhere, which is a home and school for orphan and abandoned children. We say orphanage. It is just -- it's easier , but the fact is we have community of families. That's what we have, community of families that have been broken by tragedy.

FRED DE SAM LAZARO: Today, 800 children whose parents have died or whose families are unable to care for them are housed in several centers.

This one taking in the overflow functions out of converted shipping containers. The shelters' young managers themselves grew up here, like 22-year-old Billy Jean. His mother brought him here when he was 3.

BILLY JEAN, Haiti: My mother became pregnant very early, about 16 years old, and my father took off, and then my mother couldn't take care of me. She heard about NPH and she decided to put me there.

FRED DE SAM LAZARO: His mother visits occasionally, he says, but the orphanage is very much his family.

REV. RICHARD FRECHETTE: That's our goal, to restore the family over one generation, to raise the children together so they have memories of their own childhood, restored childhood, and that later in life they become aunts and uncles to each other's children and their family regenerates after a generation. That's our goal.

FRED DE SAM LAZARO: Early in the 1990s came a new challenge for Frechette, children with HIV/AIDS.

REV. RICHARD FRECHETTE: We received some really bad occasions with almost nobody around to manage them and us with nothing but our goodwill to manage them. And that really engraved itself hard on my memory, seeing such terrible things, and honestly not having a clue.

FRED DE SAM LAZARO: So Frechette decided to become a doctor. He got his medical degree when he was in his mid-40s. His newly acquired expertise combined with astute fund-raising resulted in a modern pediatric hospital in 2006, the country's largest. A wing was added for women with high-risk pregnancies which often result in premature births. This way, such newborns are right near the 22-bed center for neonatology.

Dr. Jacqueline Gautier is the medical director.

DR. JACQUELINE GAUTIER, Medical Director: We have central oxygen. We can offer CPAP, which is external ventilation.

FRED DE SAM LAZARO: So on any given day, you have 22 kids in here who would not have lived were it not for this facility?

DR. JACQUELINE GAUTIER: Correct.

FRED DE SAM LAZARO: Then a new challenge, the devastating earthquake of 2010. The quake didn't damage this hospital, but quickly overwhelmed it.

DR. JACQUELINE GAUTIER: The yard was transformed into a trauma center. We had patients everywhere.

FRED DE SAM LAZARO: Donations poured in, $9 million in all after the quake, and were used to start a new adult hospital. But 10 months later came a new crisis, cholera, which killed nearly 5,000 people in its first year and continues to flare up, most recently as a result of Hurricane Sandy.

REV. RICHARD FRECHETTE: So we kind of mushroomed out in response to all of these problems. I think the surprise to everybody, including to us, is that we could do it all pretty much without batting an eyelash. And the real wonder of it, to tell you the truth, this is a country of no infrastructures practically, and it's a country of failed NGOs.

FRED DE SAM LAZARO: He says three years after the quake, despite billions of dollars given to thousands of NGOs, non-government organizations, the rebuilding has been painfully slow.

REV. RICHARD FRECHETTE: There's too much disjointedness. It's goodwill, and it should be recognized fully as that and appreciated, but it doesn't get channeled in a way that makes sense, and in fact it's a way that gets disruptive.

FRED DE SAM LAZARO: Many smaller NGOs have come and gone as their funding allowed. Bureaucracy has slowed larger agencies and their major projects in housing, clean water and sanitation. Some 360,000 earthquake victims remain displaced in tent camps.

So, the suffering continues and the toll presents itself starkly and literally. Each morning in the chapel of St. Damien's Children's Hospital, the shrouded bodies of those who have died, several infants and one adult on this day, are counted, the names written down for prayers that follow at daily mass.

REV. RICHARD FRECHETTE: Anybody that dies in our arms, as they say in Creole, in our place, then their body is first brought to the chapel so that the very next mass, we have the prayers for the dead and for their peace and for the transformation of their life to eternity and for the strength and courage of their family.

FRED DE SAM LAZARO: Beyond prayer, Frechette says it's important to strengthen families and communities in development work. Unlike many NGOs, project manager Raphael Louigene says this one tries to involve the community.

RAPHAEL LOUIGENE, Project Manager (through translator): Organizations come in with their own ideas and do things their own way. The way that Father Rick works is we don't come into a community and give our idea of what to do and how to do it. We listen to the community, listen to their needs because they know them the best, and then we work together to accomplish it.

FRED DE SAM LAZARO: In the sprawling Port-au-Prince slum called Cite Soleil, Louigene says the group is partnering with the community to build homes amid a sea of shacks and squalor. They're built on the principle that if you wait to do things right, nothing will get done for years, only prolonging the suffering.

REV. RICHARD FRECHETTE: We're investing in the purchase of time. You know, they're simple block structures, we make most of the blocks ourselves. They're simple aluminum roofs. It's more towards normal than anything that they have known, but we're just buying time while the people with big money and big plans, an interwoven network of organizations can do a proper urban development. That's what we're doing.

FRED DE SAM LAZARO: They're also building a new health care facility here. All told, about 1,800 Haitians work for the mission begun by Frechette. Hundreds of thousands have been served in orphanages, schools and hospitals.

Funding comes from individuals, foundations and government grants. This year, Frechette was awarded the $1 million Opus Prize, given to a faith-based social entrepreneur by the Minnesota-based Opus Foundation.

Frechette doesn't see his work for the Haitians he serves as charity.

REV. RICHARD FRECHETTE: We give them the chance that we all have had, and rather than saying, I gave you this chance, I say, I was fortunate I had that chance. It came to me. I didn't make it. And we want that same chance to come to you.

FRED DE SAM LAZARO: But, in Haiti, he admits, progress is slow and success built one small stretch at a time.

GWEN IFILL: Fred's reporting is a partnership with the Under-Told Stories Project at Saint Mary's University in Minnesota.

Understanding Why Delivering Aid Can Be a Dangerous Endeavor

Thu, 20 Dec 2012 18:22:00 EDT

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RAY SUAREZ: For more on all of this, we are joined by Joel Charny, vice president for humanitarian policy and practice at InterAction, an alliance of U.S.-based relief and development organizations.

And, Joel, let's stipulate from the get-go that anybody who continues to give out doses after these killings is just tremendously brave.

JOEL CHARNY, Humanitarian Policy and Practice, InterAction: Exactly.

RAY SUAREZ: But does this have the potential for curtailing or stopping a program that had a disease on the run?

JOEL CHARNY: Well, I think absolutely.

I mean, the -- you heard that eloquent woman leader basically saying, we're risking our lives for this. This is something that's for the future of our children.

But at some point, they will be unable to continue if the violence and the violent threats force them to -- both them and the health organizations that are working on this to curtail the programs.

RAY SUAREZ: The vaccination program in Pakistan already was under suspicion by the Taliban. But did the United States complicate things in Pakistan, and how?

JOEL CHARNY: We didn't help, because I think, as many Americans know, as part of the operation to identify Osama bin Laden's whereabouts, the CIA put together what you would have to call a bogus vaccination campaign to try and identify bin Laden's whereabouts.

This became widely known. The doctor who was a part of it ended up being sentenced to 30 years in jail. But there you have the manipulation of a pure humanitarian program for political and counterterror ends. And this was very controversial across all of Pakistani society, but especially strikes at the militants in a sense, well, here is another example of how these sort of Western programs are striking at our interests. And it undermines the credibility of what should be a basic health intervention.

RAY SUAREZ: And complicated the plea from any subsequent NGO that they're neutral, that they're not affiliated with a government?

JOEL CHARNY: Well, exactly.

Anything, any attempt to make that case, there's going to be a bit of suspicion on the part at least of the militant groups. I think there's a commitment from the Pakistani government to make these programs work up to the highest level. But in these deep rural areas where people are so far away from the center, and there's such a low level of education and so on, the ability -- I mean, we handed a propaganda tool to groups that want to undermine these programs.

RAY SUAREZ: Apart from this, looking across the world, where these programs are going on, are attacks against aid workers rising? Is this work getting more dangerous to do?

JOEL CHARNY: It is.

There's a new report out just this week saying, in 2011, security incidents, both killing and wounded, amounted to 305 in 2011. Now, that doesn't sound like a huge number, but I have been in this work long enough to remember when that number would have been less than 20 or less than 10.

There's an erosion of our ability as a humanitarian community to work safely. And we have to examine -- we can't hunker down and end the work, but we have to find ways to continue to be effective, but in the safest way that we possibly can.

RAY SUAREZ: In the safest way you can.

If you lay on more security, does that make it more difficult to be with the people you're trying to help?

JOEL CHARNY: Well, yes. And the whole point of what we try to do precisely is to be with the people, both for kind of solidarity and empathy, but also to be more effective, so that we can see the impact, so that we can be side by side with people.

And, you know, the jargon term now is bunkerization. We don't want to be behind a bunker. If we're behind a bunker, we're not effective. But at the same time, at what point do you ask people to die for the sake of a program or risk their lives for a program?

And the analysis now is, basically, if you're doing something that's lifesaving, it's worth taking more of a risk than if you're doing an ongoing program that may be able to manage itself or wouldn't hurt people so much if it were suspended.

But, I mean, this whole idea of how fundamentally important is this program to the lives of people is a question that we have to ask ourselves.

RAY SUAREZ: The state-of-the-art, I'm told by many in this community, is to use locals as much as possible. They are able to approach the people who they live among more easily. Yet, they may also understand the risks and be more reluctant to be parts of these programs, too.

JOEL CHARNY: Well, they are more -- they are more vulnerable.

I mean, when I give that figure of 305 casualties in 2011, the majority of those were among local staff, local people, local workers. So, it's, in fact, not a solution to say, well, we're going to have the expatriates out in some safe place and we're going to have the local people taking the risk.

They're willing to take the risk, just as we may be, but they're equally subject. In other words, the fact that they're from the community doesn't necessarily make them safer.

RAY SUAREZ: Does this send a chill, this incident in Pakistan, through a much wider set of relationships?

JOEL CHARNY: I think so, absolutely.

And it just -- there's just a -- it is just fundamentally wrong to see a 17-year-old woman or a 20-year-old woman or a 30-year-old woman be killed for vaccinating a child. I mean, I find that very chilling. And it's not that, OK, so now we're going to just hang it up everywhere, but the idea that this can happen in a country like Pakistan is very disturbing.

RAY SUAREZ: Joel Charny, thanks for joining us.

JOEL CHARNY: Thank you.

Program on Polio Eradication Suspended in Pakistan After 9 Aid Workers Killed

Thu, 20 Dec 2012 18:18:00 EDT

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RAY SUAREZ: The death toll of polio vaccine workers killed in a string of attacks in Pakistan climbed again today. One victim died from wounds sustained in a shooting on Wednesday.

Tom Clarke of Independent Television News narrates this report on the difficult decisions the World Health Organization faces between protecting workers and eradicating a disease.

TOM CLARKE: Hundreds turned out to bury Mohammad Hilal, to mourn the loss of a 22-year-old student who gave out polio vaccine in his spare time. But they also came to express public outrage at this week's murders.

Nine young people, six of them women, one just 17, have been gunned down since Monday, and not at random, a series of coordinated assassinations targeting an annual three-day polio vaccination campaign.

BUSHRA ARAIN, All Pakistan Lady Health Workers Association (through translator): We go out door to door and risk our lives to save innocent children from being permanently handicapped.

For what? So that our coming generations turn out to be healthy. We work for our country, and we are being rewarded in the form of death. What kind of justice is this? Why are we targeted and killed?

TOM CLARKE: Until someone claims responsibility, we won't know why. The Taliban haven't come forward, but extreme Islamist groups have long opposed Western health interventions and the role for women in campaigns.

Frustration is compounded by the fact they were making such good progress. There were just 56 cases of polio in Pakistan this year, the lowest ever.

Up until the 1950s, polio, which can paralyze 10 percent of the children it infects, was one of the world's most feared diseases. Vaccination programs have steadily eradicated it in rich countries, and in recent decades, it's been all but wiped out in the developing world, too.

When the World Health Organization launched its campaign 24 years ago, polio was found in more than 125 countries, with around 350,000 cases every year. But now it's endemic in just parts of three countries, Nigeria, Afghanistan, and Pakistan. And the cases have dwindled, 650 last year, and just 213 in 2012 so far.

The eradication program has had setbacks before, like a ban linked to extreme Islamists in Nigeria that led to outbreaks in 20 other countries. But observers say this week's violence is something new and requires the WHO to rethink the battle with polio it has so nearly won.

DR. HEIDI LARSON, London School of Hygiene and Tropical Medicine: I think it needs to think about how to do it differently, maybe not as polio for polio's sake, but in the context of health.

And I know that that's been thought about. I know that the idea of integrating and mixing with other interventions has been thought through, but maybe it needs another look.

TOM CLARKE: The WHO warned failure to eliminate polio from its last few strongholds could mean as many as 200,000 new cases every year within a decade. That would be cruel memorial to the young volunteers who were so close to wiping it out for good.

How Infections Can Trigger Cancer

Thu, 13 Dec 2012 10:08:00 EDT

Veronica Alebo, a young Burkitt's lymphoma patient, has a large tumor in her abdomen. She receives treatment at the Uganda Cancer Institute in Kampala. Photo by Jacqueline Koch. This story is part of a series, Cancer's New Battleground: the Developing World.

More than half a century ago, an Irish physician named Denis Burkitt moved to Uganda and opened a medical clinic.

He was quickly struck by the large number of children with grotesque facial swellings that often grew large enough to choke and kill. It was a type of cancer he had never seen back home.

The cancer came to be called Burkitt's lymphoma.

Today on the pediatric ward at the Uganda Cancer Institute, the beds are filled with children with Burkitt's. It's the most common childhood cancer in equatorial Africa.

And it starts with an infection.

"It's associated with a virus called Epstein-Barr virus," says the institute's Dr. Abrahams Omoding.

Epstein-Barr virus, which also causes mononucleosis, appears to initiate Burkitt's lymphoma. Malaria may also play a role in triggering the disease.

Cancer-Causing Germs

"People usually think cancers are caused either by bad habits" such as smoking or alcohol use, Omoding says, or by eating the wrong things, being exposed to radiation or chemicals, or aging. But many infections can also cause cancer.

Bacteria called H. pylori, which cause ulcers, can sometimes cause stomach cancer.

The parasite responsible for schistosomiasis, a tropical disease, can lead to bladder cancer.

Cervical cancer is caused by the human papillomavirus.

"We've [also] got liver cancer," adds Omoding. "It's associated with hepatitis B virus."

Infection with the bacterium H. pylori is a common cause of stomach cancer. (Courtesy of Dr. Nina Salama and Jennifer Taylor, Fred Hutchinson Cancer Research Center.)

And there's Kaposi's sarcoma, caused by a virus that attacks people with weak immune systems. In Uganda, where many people are HIV-positive, Kaposi's sarcoma is in epidemic proportions.

"The list is long," says Omoding. "These are the most common cancers that we see, and all of them are actually virus-related. [It's] different in the US."

In North America, only one in 25 cancers can be blamed on infectious agents. In developing countries, it's one of every four cancers, according to a recent study in the medical journal The Lancet Oncology.

The reason? Poor sanitation in developing countries means greater exposure to germs. In addition, people in places like sub-Saharan Africa aren't likely to be vaccinated against viruses that can cause cancer, such as the hepatitis B virus.

Deciphering the Link

8,800 miles from Kampala, in Seattle, Washington, scientists at the Fred Hutchinson Cancer Research Center are trying to figure out how viruses cause cancer.

In Mei Lei Huang's laboratory, researchers get shipments from Uganda every other month.

"If it's [a] blood sample or tissue, it will come in dry ice," she says.

The samples go in freezers that line one wall.

The samples are part of a study of Burkitt's lymphoma. Scientists want to determine how long the cancer takes to develop after a child is infected with Epstein-Barr virus.

Larry Corey, head of the Fred Hutchinson Cancer Research Center, says the work is aimed at one goal. "Can we intervene? Can we alter the underlying development of cancer by attacking the virus?"

The biological link between infections and cancers works like this: Invading organisms infect cells and disrupt the cells' normal workings. The Epstein-Barr virus, for example, infects immune system cells called B cells and causes them to grow.

Human herpesviruses (indicated by arrows) exiting a cell. Two types of herpesvirus are known to cause cancers such as lymphoma, nasopharyngeal cancer, and Kaposi's sarcoma. (Courtesy of Dr. Soren Gantt, Fred Hutchinson Cancer Research Center.)

"The more they grow, the more they divide," Corey explains. "The more they divide, the more the chance there is of an alteration of the genetic material during the division phase." That alteration causes cells to grow out of control and become cancerous.

The Goal: Prevention

But Corey says there is good news about infectious organisms and cancer: The link between the two can be broken.

"If you know an infection is the cause of cancer, if you attack the infection, you can actually prevent the cancer."

That is already happening with the HPV vaccine, which protects against many of the viruses that cause cervical cancer and some other cancers.

Similar success is being seen with hepatitis B. It can lead to liver cancer--a leading cause of cancer death in China--but thanks to vaccine programs that began in the 1990s, liver cancer deaths in China have begun to drop.

There is no vaccine yet that can prevent children in Uganda from getting Burkitt's lymphoma, but Corey's scientists in Seattle and their colleagues in Kampala are working on it--together.

Corey's long-term dream is to see vaccines against all infections related to cancer. If achieved, that would drop the world's cancer death rate by about 20 percent.

This story is the fourth in a five-part series produced by PRI and with the support of the Pulitzer Center on Crisis Reporting. The week of Dec. 10, the PBS NewsHour will post one story from the series per day. You can view the entire series on PRI's website or view additional infographics from the stories here.

Fighting Cholera, A Dose at a Time

Wed, 12 Dec 2012 11:34:00 EDT

Photo by Jon Lascher/Partners in Health.

The United Nations announced a $2.2 billion initiative Tuesday aimed at curbing the spread of cholera in Haiti over the next 10 years through improved water and sanitation projects. The plan put forward by U.N. Secretary-General Ban Ki-moon also calls for funding a new tool in health officials' toolkit to combat the disease -- a cholera vaccine.

"The main focus is on the extension of clean drinking water and sanitation systems," Ban said. "But we are also determined to save lives now through the use of an oral cholera vaccine."

"Because global vaccines are in short supply, we will first target high-risk areas: densely populated urban areas and rural areas far removed from health services," Ban added. "As production increases, the vaccine effort will expand its reach."

As NewsHour special correspondent Fred de Sam Lazaro highlighted in his recent report, cholera continues to have a devastating impact on the island nation, nearly three years after the tragic earthquake. Cholera is a waterborne bacterial disease, which causes severe diarrhea and can lead to dehydration and death.

Approximately 7,700 people have been killed and 620,000 have been infected, although some aid groups on the ground believe the actual figures are even higher. Only 17 percent of Haitians have access to improved sanitation and clean water, conditions which fuel the spread of the disease.

Until recently, the use of a widespread cholera vaccine initiative to prevent the disease in Haiti was considered controversial. The Haitian government and some international medical groups such as the Pan American Health Organization were initially skeptical that a massive vaccine rollout would be feasible given the tricky distribution logistics involved. The oral vaccine must be refrigerated and is given in two doses, two weeks apart. Immunity lasts two to three years and the vaccine is about 65 percent effective. There were also concerns that vaccination campaign would pull financial resources away from much-needed water and sanitation projects.

But last year, the Haitian Ministry of Health decided to back a pilot project to vaccinate 100,000 people living in two areas of the country, a slum in Port-au-Prince and a rural, rice-growing area in the Artibonite River Valley. The campaign was a joint effort by the Ministry of Health, Boston-based nonprofit Partners in Health (PIH), and the Haitian nongovernmental organization GHESKIO.

From mid-April to mid-June, teams of community health workers fanned out to reach as many people as possible in the two regions. "We were very pleased with the results," said Dr. Louise Ivers, PIH's senior health and policy advisor.

In the rural areas where PIH teams coordinated the vaccinations, Ivers says they reached about 80 percent of the population. And of the people who received the first dose of vaccination, 90.8 percent received a second dose. Similar results were reported in the urban areas.

"We were particularly interested to see if we would reach a threshold level," said Ivers. "When you reach about 50 percent of the community, the people who haven't been vaccinated become protected. So that means we would be seeing 'herd immunity' in that area."

Ivers says one of their biggest challenges was a six-week delay in the rollout caused by an erroneous local radio report that said an experimental vaccine was being used. After everything was cleared up, and Ministry of Health gave the green light, the rainy season had started and health workers had a difficult time reaching some of the rural areas.

To further complicate matters, the delay caused the cholera vaccine distribution to overlap with a pre-planned national polio vaccine campaign. Because much is unknown about cholera and polio vaccine interactions, health officials decided to wait to give children the cholera vaccine one week after they had received a polio vaccine. Ivers says that meant every area targeted had to be visited four times, instead of just twice.

Despite all the challenges, Ivers says the pilot project was a success and showed what could be possible with a vaccination campaign targeting the entire country.

"We found that there was a huge interest in the vaccine," said Ivers. "There was not any built-in fear or skepticism from communities once we engaged them and explained what we were doing and asked them if this is something they wanted. I think the fact that so many people have been personally impacted by cholera, there was a strong desire to take any tools that might be available to prevent it from happening again."

Ivers believes the battle against cholera in Haiti must be fought on multiple fronts. "We are completely behind the issues of water and sanitation. Those are the gold standard ways to fix the problem," said Ivers. "But investments in public water and sanitation projects take years and billions of dollars. So this is a bridge to that. There's no reason why you can't use the cholera vaccine for a limited time and then make progress on sanitation projects."

Currently, PIH is distributing several thousand remaining doses from the pilot project to another small community. And they are working with the country's Ministry of Health to figure out next steps, while providing ongoing treatment for those who are ill. The United Nations endorsement this week should provide a boost for a larger rollout of the vaccine throughout Haiti in the coming years.

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In India, A Secret Weapon Against Cancer: Vinegar

Wed, 12 Dec 2012 09:50:00 EDT

This story is part of a series, Cancer's New Battleground: the Developing World. Above: Indian women participate in a women's march in Mumbai on Monday. Photo by Roberto Schmidt/AFP/Getty Images.

Cervical cancer used to kill more women in the United States than any other cancer. Today, deaths in the U.S. are almost unheard of thanks to a decades-old test called a Pap smear, which allows for early detection and treatment.

In India, however, tens of thousands of women still die each year from cervical cancer.

"It's just not possible for us to provide [the Pap test] as frequently as it is done in the West," says Dr. Surendra Shastri, a cancer specialist at Tata Memorial Hospital in Mumbai.

The Pap test requires trained personnel and well-equipped labs, which many parts of India do not have.

"So what do we do?" Shastri asks. "We can't let the women die."

It turns out there may be a simple answer. It's a cheap and easy test developed by scientists at Johns Hopkins University and other institutions. And it relies on something you probably have in your kitchen.

Acid Test

I came to the village of Dervan in the Indian state of Maharashtra to see how the test works.

Doctors had set up a temporary clinic in the shell of an empty store. A sheet hung from the ceiling to provide some privacy. There was no electricity -- not even a light bulb -- in the storefront.

About a dozen Muslim women in headscarves had come for the test. One was on the exam table, her long brown skirt pushed aside. With her friends sitting nearby, she looked calm and ready.

Dr. Archana Saunke took a cotton swab and applied a clear liquid to the woman's cervix.

"We wait for one minute, and we see if there is any patch -- yellowish patch," she explained.

If the liquid makes the normally pink cervix turn white or yellow, that means there are precancerous cells -- cells that could become cancer.

Within a minute or two, the doctor had some good news for her patient.

"It's normal," Saunke said. The woman smiled broadly.

When tests yield bad news and show precancerous cells, those can be removed on the spot with a squirt of liquid nitrogen. No return trip is needed.

So what is this clear liquid Dr. Saunke applied?

"Acetic acid," she says. Common household vinegar.

Overcoming Resistance

The tests being done here are part of a trial program being run by Tata Memorial Hospital and Walawalkar Hospital, where Dr. Suvarna Patil is medical director.

Patil says when the vinegar test was first brought to the villages, women were not interested, even though it was free.

"Whenever we used to go to their houses, they used to shut the doors. They would say, 'No, we don't want [it]. You go away.'"

Patil says many women found testing a bother. They were embarrassed to have a vaginal exam, and for what? They didn't think cancer could be treated.

India being a country of high- and low-tech solutions, Patil sent out health workers with computers loaded with PowerPoint presentations. They put up posters around town and performed plays. They talked to students in schools and to village leaders.

Still, Patil says, the women wouldn't come.

"Muslim ladies, they will never come because it's their culture," she says. "Even Indian ladies, they are very shy. So first what we did is we appointed [an] all-female staff."

The staff got awareness training. They were taught to test not just for cervical cancer, but also for high blood pressure, dental problems, diabetes, and other diseases women were worried about. Men were also invited for those other screenings -- and male support for the program was a key factor for the women.

All that got women in the door. Then it was a matter of time for attitudes to change.

Positive Results

Patil says it made a big difference when women saw other women actually beat cancer.

"Now they are seeing the results, because if the cancer is picked up in early condition, the patient is doing well," she says. "People are coming to us and telling us, 'Please arrange a cancer screening camp for our ladies.' But it took eight years. It was so difficult."

It is evident that those eight years have paid off.

Back at the temporary testing clinic, Sojata Sanjay Kapril said she was happy she underwent the screening. Her test result was negative, but she said if an abnormality had been found, "then we can cure it."

The vinegar technique has been adopted in several countries now, and there's another more expensive test for cervical cancer that some say may eventually prove to be even better.

These tests could save the lives of tens of thousands of women in India each year--as long as women continue to be convinced to use them.

This story is the third in a five-part series produced by PRI and with the support of the Pulitzer Center on Crisis Reporting. The week of Dec. 10, the PBS NewsHour will post one story from the series per day. You can view the entire series on PRI's website or view additional infographics from the stories here.

Living With Breast Cancer Where Treatment Is Scarce

Tue, 11 Dec 2012 11:23:00 EDT

This story is part of a series, Cancer's New Battleground, the Developing World. Above, Haitians wait for the doors to open in 2006 at a free clinic in Cange. Photo by Thony Belizaire/AFP/Getty Images.

Haiti is the poorest country in the Western Hemisphere. Having breast cancer there often means no care at all, or care that's too costly for any common person to afford, or a lot of initial missteps.

"I felt something in my breast that hurt," says a woman who asked to be identified only by her first name, Merlyn.

She's a big woman in tight braids, with a tough look on her face and a forceful way of speaking. But, she admits, she was scared.

"It hurt," she says. "It formed a mass. I didn't know what it was."

Merlyn says the lump grew so large that it broke through her skin. Her clothes couldn't cover it. Local doctors were no help.

Merlyn eventually got referred a clinic run by Haitians and Americans from Partners In Health, a medical charity that has launched a new push to fight cancer.

"The reason we're taking it on is similar to the reasons we've taken on other illnesses," says Dr. Sara Stulac, who heads the group's oncology program. "People are suffering in the countries where we work, and there's something we can do about it."

Preparing for the Fight

In the little Haitian town of Cange, Partners In Health's sister organization -- known in the local language (Kreyol) as Zanmi Lasante -- runs a clinic.

The clinic has been setting up cancer treatment rooms, lining up supplies, and training workers on cancer issues. They are focusing on breast and cervical cancers -- the most common cancers among Haitian women.

Dealing with breast cancer in a place like Haiti takes effort and compromise.

The effort starts with the patients. When Merlyn showed up at the clinic with advanced breast cancer, she got a mastectomy. Now every two weeks she takes a 12-hour trip on one of Haiti's creaky and overcrowded buses to get to the clinic for chemotherapy.

Merlyn says she is bucking what her neighbors say.

"If you get cancer, people say you're going to die because there's no treatment for it," she explains. "They say even if you see a doctor, you won't find a solution. That's the talk."

The breast cancer statistics for women like Merlyn are grim.

"I don't have a definite number, but I can say that it's very bad," says Dr. Ruth Damuse, who is heading the oncology efforts at Zanmi Lasante. "Like half of the women, they will die."

Damuse says the biggest problem is women coming in late, long after they've noticed the initial lump. And a lot of women don't come in at all. So Damuse takes every opportunity to preach early diagnosis.

Reaching Out

On International Women's Day, Damuse traveled a few towns over from her clinic to attend a rally and teach-in. Several hundred women sat in the large lobby of a new hospital that was under construction.

Damuse took the podium and asked the crowd a question: "Which cancer most affects women?"

The crowd murmured. No one knew the answer.

"We're going to talk about breast cancer," Damuse continued.

On two screens flanking the podium, Damuse showed pictures of breast cancer patients like Merlyn, with tumors coming out of their chests. She told the women how to check themselves for suspicious lumps. She said treatment makes a difference.

The women sitting next to me said it was all new to them.

Cancer care is a new thing in many developing countries. With all the other health problems facing the poor, there has been little interest in cancer treatment among local and international health experts.

Sara Stulac of Partners In Health says for a medical charity like hers, focusing on cancer means getting organized. "You do have to make sure that you have access to advice, to diagnoses, to medications."

And patients need some sort of social support system to help them get to the hospital. That is no small order in countries with bad roads -- or no roads.

With patients coming in so late, diagnosis and treatment often fail, so last year the Haiti medical workers received training in how to use painkillers and provide other comfort care for people dying of cancer.

Help from Abroad

For medical advice, the clinic in Haiti relies on experts at the renowned Dana Farber Cancer Institute in Boston.

The doctors and nurses in Haiti check in once a week with Dana Farber. They gather around a speakerphone in a simple stucco house near the hospital.

During one call, seven patients were up for discussion. Four were women with breast cancer.

Dr. Lawrence Shulman, head of Dana Farber, joined the call from Boston. He had been sent the patients' medical histories, lab results, and what X-rays were available.

One woman had had a mastectomy last fall, but the cancer returned. Shulman suggested a different kind of chemotherapy.

Another young woman had a breast lump removed. In the U.S., lumpectomies generally require weeks of daily radiation treatments after the surgery, but Zanmi Lasante doesn't have any way to administer radiation. So Shulman suggested a full breast removal.

"She needs to go back and have a mastectomy," Shulman said over the phone. "Then she needs five years of tamoxifen."

The tamoxifen costs just pennies a day, affordable even in Haiti. And there are other opportunities to keep costs down. In Haiti -- for unknown reasons -- breast cancer mostly hits women in their 20s and 30s, and mammography does not work well in women this age, so Zanmi Lasante doesn't offer it.

Cancer surgery, chemotherapy, and after-care can be costly, however. Partners In Health provides all of this for free and relies on donors to finance it.

Making Cancer a Priority

Sara Stulac, the head of Partners In Health's cancer program, admits that her team is taking on a big challenge in a country with many other problems.

"I think some people would say we shouldn't [tackle cancer], but the fact is people are suffering and dying," she says. "We can't save all of them, and we can't save the same group of patients with the same group of diagnoses that we can in the US, but there is so much suffering that we can avoid, and there are so many cancers that we can treat."

People used to say that AIDS drugs were too costly and too difficult to deliver in developing countries, yet millions of people with HIV in places like Africa and Haiti are now being saved. Stulac says there's no reason that can't happen with cancer.

This story is the second in a five-part series produced by PRI and with the support of the Pulitzer Center on Crisis Reporting. The week of Dec. 10, the PBS NewsHour will post one story from the series per day. You can view the entire series on PRI's website or view additional infographics from the stories here.

Cancer's New Battleground: The Developing World

Mon, 10 Dec 2012 13:24:00 EDT

Uganda Cancer Institute. Photo by Jacqueline Koch.

This story is the first in a five-part series produced by PRI in collaboration with the Pulitzer Center on Crisis Reporting. The week of Dec. 10, the PBS NewsHour will post one story from the series per day. You can view the entire series on PRI's website or view additional infographics from the stories here.

Jackson Orem is a busy man. He directs the Uganda Cancer Institute -- the only dedicated cancer treatment facility in a country of 33 million people.

Yet he still finds time to see patients, like Musa Settimba.

"Good to see you," Orem says as he enters a small exam room furnished with little more than a chair and table.

"Good morning, Doctor," says Settimba.

Settimba is here for a checkup. He has a type of gastrointestinal cancer that is often fatal, even in countries with access to the latest medical care.

Orem has arranged for Settimba to get Gleevec -- a very effective and costly new cancer drug -- for free, courtesy of the manufacturer. There's paperwork involved, and drugs for only a few cancers are available this way. It's a godsend for Settimba, who has been doing very well.

"You are getting one of the best treatments for this disease," Orem tells his patient.

Unfortunately, Settimba is the rare exception.

Hear Orem discuss the challenges in this video slide show:

Discouraging Statistics

The survival rate for patients who make it to the Uganda Cancer Institute is astonishingly low.

"We get about 22,000 new cases [annually]," says Orem. Of those, 20,000 die within a year.

Orem says most Ugandans don't have a real concept of cancer as a set of diseases that can be diagnosed and treated. In some tribal languages, there is no word for cancer.

"People are dying because they don't have a system," Orem says. "They don't have early diagnosis. They don't actually even know that they have cancer."

And the people who do realize they have cancer often hide it. They fear being stigmatized, and "once you are diagnosed with cancer, they think that it's already a death sentence," says Orem.

They're partly right. Most people don't come in until the very last stages of cancer. At that point, no doctor anywhere could do much for them.

Lack of Attention

Orem studied oncology at Case Western Reserve University in the United States and then came back to Uganda to head this government-owned cancer institute in 2004. For several years, he was the only oncologist in the entire country.

"It was really very, very demanding," he says. "I can't explain how I was managing, because actually I was doing everything."

Orem doesn't complain about the hard work, but some things make him cringe. One of them is a comment he's heard expressed by people from developed countries -- that cancer doesn't hit poor people.

"People think that malaria kills [and] other diseases are killing people from a low socioeconomic status. But cancer is the same," he says. "The truth of the matter is that cancer is a disease of the African person just like any other person elsewhere in the world."

The perception that cancer is not a problem of Africans leads to a lack of money, he says.

"When you ask for funding for cancer, nobody is going to give [it to] you. But if you ask for funding for these other diseases, they say, 'All right, your priority is correct, we are going to give you some funds.' I think that is actually the reason why things are the way they are."

There is also a perception that cancer is too expensive to treat, and treatment is too high tech, to be done in poor countries. Orem says that's not necessarily true.

A New Push

Orem takes me for a walk up a hill so we can see the Uganda Cancer Institute's expansion plans.

The Ugandan government is putting up what will be a modern 200-bed cancer hospital to replace the 120 bare-bones beds of the current Institute down below.

"You see that expanse of a building with a blue roof?" Orem says, pointing. "That is the outpatient department."

In that building is a clinic like some you might see in the U.S., where patients receive chemotherapy through intravenous lines. There is also a building with the beginnings of a modern pharmacy.

None of the buildings include a gamma beam generator or a robot that can do surgery, but some conditions can be treated as successfully here as in the U.S.

And now Orem has the help of five Ugandan cancer specialists who recently received training in Seattle, at the Fred Hutchinson Cancer Research Center.

What keeps Orem going is that people in the West are beginning to take interest.

Last year, the United Nations urged that more be done to detect and treat cancer in the developing world. George and Laura Bush recently toured Africa to bring attention to breast and cervical cancer.

"People are much more receptive to our messages than before," Orem says. "It looks like we are beginning to make an inroad."

Still, he says, when it comes to fighting cancer, Uganda is just at the starting point.

Listen to Joanne Silberner's radio version of this report here:

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Long After Earthquake, Haiti Still Feels Devastating Effects of Cholera Epidemic

Tue, 04 Dec 2012 18:37:00 EDT

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FRED DE SAM LAZARO: The 2010 earthquake that devastated Haiti may still loom large in Americans' memory, but, in Haiti itself, that was at least three disasters ago, before Hurricanes Tomas last year, Isaac in August, and recently Sandy.

Each storm brought a grim reminder of yet one more ever-present disaster: the deadly cholera epidemic that started 10 months after the quake.

At the cholera ward of Saint Luc's Hospital just outside the capital, Port-au-Prince, Dr. Jackinson Davilmar says since Hurricane Sandy admissions have doubled from 20 to 40 patients each day.

DR. JACKINSON DAVILMAR, Saint Luc Medical Center (through translator): Most of the new cases are coming from further up the hill in places like Petionville where we had not seen them before. I'm not positive, but perhaps the wells there have been contaminated.

FRED DE SAM LAZARO: Experts believe cholera was brought here by U.N. peacekeepers at the time, a battalion from Nepal. Untreated sewage from this base flowed into a tributary of the ArtiboniteRiver, the major source of water for both washing and drinking.

Cholera is spread by fecal-oral contact. Two years on, 200,000 patients have been sickened, 7,500 have died from the extreme diarrhea and fluid loss. Each flood brings more contaminated water, more cases.

The epidemic prompted massive relief efforts and public campaigns on the streets and in classrooms promoting hygiene and sanitation. Fatalities have dropped from 10 percent of cases early on to about 1 percent.

Still, 600 people have died from cholera this year, many in remote areas, even those unaffected by floods. There's now plenty of awareness of cholera in Haiti. The biggest challenge for people today is distance.

As the epidemic subsided over the last few months, many treatment centers have been closed in the remote areas. So, getting to places that remain open is a huge challenge. It can take hours. And that delay can be fatal.

Sentiment Joseph, a 27-year-old mother of three, will likely recover, having made it in time to get prompt antibiotics and rehydration therapy. Her husband wasn't so lucky. He died a week earlier in their home less than an hour away by motorcycle.

SENTIMENT JOSEPH, Cholera survivor (through translator): He took ill around midnight. There was no one to care for the children, no means to bring him in. We didn't have the money to hire a motorcycle.

FRED DE SAM LAZARO: Across this spartan treatment center run by the Boston-based charity Partners in Health, other challenges were apparent from patient stories.

MAN (through translator): We don't have hygienic facilities. We treat our water, but don't have a formal latrine.

MAN (through translator): I was staying in my sister's home, and I'm not sure she treated the water.

MAN (through translator): There are 14 people living in our house. And it's very expensive to treat the water for so many people. And our only latrine was destroyed in a road-building project. So, we don't have that.

FRED DE SAM LAZARO: Cholera, not seen in Haiti for almost a century since 2010, is likely to remain for some time, says Partners in Health physician David Walton.

DR. DAVID WALTON, Partners in Health: Cholera endemic to the region, to the country is the last thing that they needed. Permanent solutions need to be put in play to be able to really stem the tide of this epidemic that is still ongoing.

FRED DE SAM LAZARO: He says cholera's persistence is a proxy for a much larger rebuilding effort that's fallen short, one that should have provided far more access to clean water and sanitation.

DR. DAVID WALTON: On a scale of A. through F., it's a D.

FRED DE SAM LAZARO: At least 360,000 people remain in crowded tent camps, he notes. Other people have rebuilt in poor neighborhoods destroyed in the quake, like this one in the hilly suburb of Petionville.

Water had to be carried in. And there are few toilets, so there's a threat of cholera.

James Sanvil lives in the U.S., but was visiting family here.

JAMES SANVIL, Haiti: There is no water, no way for them to get water down here, because there's no water came, like, down here.

FRED DE SAM LAZARO: Kevin Fussell is one of many small providers who have tried to bring relief. He's a Georgia physician who started a charity to provide safe drinking water.

His group installed clean water facilities into six schools in the central Haitian town of Mirebalais before running out of donated funds.

He says they'd like to put in many more, but have had no luck applying for funds the U.N. has for water projects.

DR. KEVIN FUSSELL, World Water Relief: They're basically trying to come up wore water solutions for an entire country. And we're working in a very small region. And they're looking for bigger global solutions.

My problem with that thinking is that three years later somebody is still thinking about global solutions, when we have real problems right here. And nothing is being done.

FRED DE SAM LAZARO: That's a complaint that's widely heard. In water and sanitation projects or anything else, there's little to show for the billions in aid that came in or was pledged to Haiti, says human rights activist Antonil Mortime.

ANTONIL MORTIME, Human Rights activist (through translator): I have talked to people in the tent camps. If you look at Cite Soleil, you can see that the situation is actually worse.

There's no change with education, with infrastructure or health care. Corruption, poverty and hunger haven't decreased.

FRED DE SAM LAZARO: Nigel Fisher, head of the U.N.'s large Haiti mission here, acknowledges the slow pace, but says there has been some progress on the massive rebuilding task, a much smaller number of tent dwellings since last year, for example.

NIGEL FISHER, Deputy special representative of the U.N. Secretary-General: If Haiti were a glass, and it's gone from being 10 percent full to 15 percent full, let's recognize that without in any way diminishing the fact that you have still got 85 percent of the glass full.

FRED DE SAM LAZARO: But Fisher says many of the problems were endemic to Haiti long before the earthquake.

NIGEL FISHER: What we're seeing is people who are in camps because of entrenched poverty. Many of these people were hidden before in slums. They're now in the open in camps.

And that is a function of underdevelopment. It's a function of weak governance. It's a function of lack of alternatives, and which these people faced before.

FRED DE SAM LAZARO: He says one of the biggest problems is that Haiti's government, crippled by the quake and a corrupt reputation, hasn't been able to lay down national priorities for the rebuilding.

That's largely been led by foreign non-government organizations, at least 10,000 of them, everything from small church groups to the large international agencies. NGOs have received more than 90 percent of all aid dollars.

DR. DAVID WALTON: The amount of redundancy with the more than 10,000 NGOs that the U.N. special envoy's office has estimated exist Haiti just leaves one wondering where all the money has gone.

And, frankly, if you look at, as they have done, where all the money has gone, hardly any of it has gone to strengthen the government.

FRED DE SAM LAZARO: Partners in Health, which has been in Haiti for 25 years, is trying to restore what it says is the appropriate role for the government.

DR. DAVID WALTON: So, 60 percent of our beds have medical gas. They also have electrical receptacles and data capacity.

FRED DE SAM LAZARO: The group raised $22 million to build a 300-bed state-of-the-art teaching hospital in central Haiti. However, it then partnered with Haiti's Ministry of Health to design and run it. It will turn over the hospital to the government in 10 years.

Dr. Walton says Haiti can never be rebuilt unless it has a strong, accountable government.

DR. DAVID WALTON: It would be so much easier for us to run it the way we wanted to run it and not coordinate with anybody but ourselves, because, hey, we're really smart, or at least we think we are.

FRED DE SAM LAZARO: And you are the guys with the money.

DR. DAVID WALTON: We are the guys with the money. And, again, NGOs don't guarantee the right of health to citizens of any country. But the government does. And we see ourselves as supporting the government.

FRED DE SAM LAZARO: President Michel Martelly cut the ribbon on the new hospital, vowing his administration will do better.

International donors, who have withheld half the $5 billion they pledged to rebuild Haiti, will closely watch how projects like this hospital fare.

For many ordinary Haitians, the goal, as one health worker put it, is to make it to the end of each day alive.

2012 World AIDS Day: Strides Taken Towards Cure, But Daunting Hurdles Remain

Fri, 30 Nov 2012 18:18:00 EDT

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MARGARET WARNER: Countries around the globe will mark World AIDS Day this weekend. The toll of the disease is still enormous. More than 30 million have died since the epidemic broke out. And AIDS accounted for 1.7 million deaths last year.

But there is growing optimism about curbing and perhaps ending the epidemic for the next generation, even as daunting hurdles remain.

Ray Suarez has the story.

RAY SUAREZ: The numbers are still staggering. Some number 34 million are live well HIV, almost 5 million more than a decade ago. The U.S. substantially increased its commitment to fighting AIDS under President George W. Bush.

Yesterday, Secretary of State Hillary Clinton unveiled the Obama administration's road map to increase access to treatment and eliminate new infections in children by 2015.

SECRETARY OF STATE HILLARY CLINTON: So, as we continue to drive down the number of new infections and drive up the number of people on treatment, eventually, we will be able to treat more people than become infected every year. That will be the tipping point. We will then get ahead of the pandemic and an AIDS-free generation will be in our sight.

RAY SUAREZ: It's been more than 30 years since the first known AIDS cases appeared in 1981. In the early years, contracting AIDS was a near-certain death sentence.

JIM LEHRER: There are few scarier things than the discovery of a new killer disease, one medical science admits is mostly a mystery for which there is no certain cause or cure. Doctors have called the new one bizarre, frustrating, frightening.

RAY SUAREZ: Yet, wider access to drugs in recent years has changed the way people live with AIDS. Deaths have dropped by 26 percent from their highest levels in 2005. New infection rates have fallen by 50 percent in more than two dozen countries, 13 of them in Sub-Saharan Africa.

Those modern achievements are due in part to activists who took on policy-makers and the medical establishment early on to fight for new approaches to treatment.

A new documentary, "How to Survive a Plague," chronicles the uphill journey.

MAN: This is it. This is the plan we're presenting. We need our government to read this plan. We need them to work with us. If they want to change it a little, we will talk to them.

But I want them to adopt it. I want them to get started on it. I want them to save our lives. Thank you.

RAY SUAREZ: These days, governments are doing more. But big problems remain. Some seven million people in developing countries still can't get the drugs they need. And in the U.S., a new report found more than half of HIV-infected young people are unaware of their status.

Dr. Anthony Fauci has been on the front lines of this battle for the past 30 years. He's head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, where he joins us this evening.

Dr. Fauci, good to you have with us on the eve another World AIDS Day.

Is there embedded in that statistic, 34 million people living with AIDS, both good news and bad news, that people are living, but still continue to get infected?

DR. ANTHONY FAUCI, National Institute of Allergy and Infectious Diseases: That is correct. And that is the reason why there is such an important push going on domestically and internationally, where most of the cases are, to get people into a treatment regimen, because what's become clear over the past couple of years, that despite those daunting statistics, that when you treat people, identify people who are HIV-infected, you not only give them lifesaving therapy, but you dramatically diminish the likelihood that they will infect their sexual partners.

And so although the numbers are very high, we are now starting to go in the direction in several countries where the death rates are down, where the infection incidence is down, and where we're getting more people on therapy than we actually are getting newly infected. And we call that the tipping point.

And we're starting to see that in some countries. So the bad news is that it's still an immense epidemic/pandemic, but the good news is that we are clearly going in the right direction.

RAY SUAREZ: It's been 16 years since the combination therapies have really widely taken hold. Looking back over your shoulder, did it work better than you had even hoped back in 1996?

DR. ANTHONY FAUCI: Well, yes, yes. In many respects, Ray, it did work better, because we had been incrementally with newer drugs, one drug and then two drugs in combination, doing better and better.

But the idea of being able to suppress the virus to the point where you actually transform the life of an HIV-infected individual, where you have patients who otherwise would have died, who had been very, very debilitated essentially leading normal lives, and the statistics now are proving that to be the case, because we know now that if you put a young person in their mid-20s who is newly infected on these drugs in an appropriate combination, you can predict that they would live an additional 50 years to almost a normal life span.

I really -- even though we were doing every day over decades, I really didn't imagine that we would have been this successful with having a combination that could do that. The real thing now is to implement that and get that to the people that need it. So that's really the challenge for the future.

Although the data are very encouraging, we still need to implement. And that's what we're talking about in World AIDS Day this year in 2012, that although we have accomplished a lot, we still have major challenges.

RAY SUAREZ: Your perspective is won the hard way, day by day over the decades. In the documentary "How to Survive the Plague," we see a shockingly young Tony Fauci, but we also see and are reminded of the terrible toll the early days of this disease took. Take us back to that time.

DR. ANTHONY FAUCI: Those are very dark years, Ray.

Before we had any therapy, it was like putting a Band-Aid on a hemorrhage. We had people who were presenting and not knowing that they were ill until they were far advanced in their illness.

My own personal experience was very dark and very depressing in many respects, although dealing with the patients gave me and them hope.

For example, in the mid-'80s, when I would be seeing patients here in the Washington area, that the median survival was six to eight months, which means that 50 percent of my patients would be dead in six to eight months. That was a terrible statistic and very painful for everyone involved.

And to have over the decades transformed into where we are now is an extraordinary accomplishment. And that's the reason why we are -- we're energized because we have been so successful to make sure this gets very broadly implemented both domestically and internationally.

RAY SUAREZ: In one of the earliest publish pieces you wrote on the disease, before we even knew it was caused for sure by a virus, you wrote: "The mortality may well approach 100 percent, making this one of the most extraordinary transmissible diseases in history."

Even though the mortality is way down from 100 percent, is it that, one of the most extraordinary transmissible diseases in history?

DR. ANTHONY FAUCI: Oh, there is no doubt about that, Ray, that -- by anybody's accounting, that if you look historically over centuries at the handful of diseases that have been public health disasters, the bubonic plague, the influenza pandemic of 1918, the smallpox pandemics, the measle pandemics, clearly, HIV-AIDS is in the very, very short list of one of the most devastating pandemics in the history of our civilization.

And that is not hyperbole. You look at the numbers, you look to see what has happened, and that is just the fact.

RAY SUAREZ: Right now, the big frontier seems to be lowering sexual transmission, because we have apparently caused great decreases in the mother-to-child in utero transmission. How come that is so much more stubborn?

DR. ANTHONY FAUCI: Well, it is sexual behavior, and it is very, very difficult when you have something that is so natural to the human species to get people to avoid risks.

I mean, for example, if you look here in the United States, the majority of cases are actually among men who have sex with men, particularly among the African-American population.

If you look internationally, where 90-plus percent of the cases are, male-to-female heterosexual transmissibility is the overwhelming modality of transmissibility.

As part of human nature, people take risks or even people don't even understand what the risks are. And that is a tough nut to crack when you are dealing with it.

That is the reason why educating and getting people to be tested, to identify whether they are infected or not and to counsel them if they are not infected and get them into a care treatment program if they are infected is so terribly important.

RAY SUAREZ: A lot of reasons to be encouraged and a lot of challenges ahead.

Dr. Anthony Fauci, thanks for joining us.

DR. ANTHONY FAUCI: You're quite welcome.

RAY SUAREZ: And, online, you can watch my interview with the director of the documentary we just mentioned, "How to Survive a Plague." Plus, we ask journalist Jon Cohen to take stock of the latest AIDS developments.

Is the World Any Closer to Ending AIDS?

Fri, 30 Nov 2012 14:07:00 EDT

An Indian child walks past a mural painted on the side of a train Kolkata in West Bengal, India. India has the world's third largest population living with HIV/AIDS. Photo by Dibyangshu Sarkar/ AFP/ Getty Images.

An AIDS-free generation? Sounds hopeful enough, but if the latest HIV catchphrase has you gazing optimistically at today's youth, you might want to look a bit further down the line.

Only 13 percent of high schoolers and 35 percent of 18- to 24-year-olds have been tested for HIV, even though the group accounts for more than a quarter of new infections (26 percent) in the United States. That means that more than 1,000 young Americans contract HIV every month and the vast majority -- roughly 60 percent -- don't know it, won't seek treatment and can easily and unknowingly pass the virus on to others, according to the Centers for Disease Control and Prevention's most recent Vital Signs report.

Those are just some of the new figures circulating in the lead-up to World AIDS Day, which is Saturday. Not all the data are bad. Far from it.

Take, for instance, some of the stats from a new UNAIDS report, which shows progress being made on a number of fronts:

AIDS-related deaths are down globally: They fell to 1.7 million in 2011, down from 2.3 million in 2005.

New infections are down globally: They fell to 2.5 million new cases in 2011 -- a full 20 percent lower than in 2001.

Treatment is up globally: The number of people receiving life-saving drugs is up 20-fold since 2003. By the end of 2011, around 8 million people were being treated with AIDS drugs around the world.

Yet in the same breath as the optimism, UNAIDS officials are quick to add that the world has a long way to go before reaching the AIDS goals it set for itself back in 2011, which include universal access to antiretroviral therapy and cutting in half the sexual transmission of HIV.

So what's it all mean? With treatment up, deaths down, a "startling" number of U.S. teenagers infected and a mixed report on the 2015 goals, what's the take-home message this year on World AIDS Day?

Here to help us contextualize this year's AIDS figures is Jon Cohen, a Science magazine correspondent who has long covered the domestic and global fight against HIV.

Let's start with this recent UNAIDS report. What did you find to be most significant?

Cohen: There's a lot of progress being made in getting antiretroviral treatment to more people. The number receiving treatment is up to eight million people right now in low- and middle-income countries. But there are 15 million people in need, so there are seven million who still aren't receiving drugs, who need treatment now. And the goal is by 2015, to get drugs to all of those people. It doesn't look like it's going to happen.

There's also a goal to reduce sexual transmission between 2011 and 2015 by 50 percent. And there's been a reduction in transmission, but about half of it is within mother-to-child transmission. It's not sexual transmission, which remains the main driver of the epidemic.

Another goal is to reduce transmission by injecting drug use by 50 percent. It turns out that the places that have the highest transmission by injecting drug use are in many cases doing the least to seriously address the problem.

So there's good news in the sense that the epidemic has stabilized, that new infections are dropping compared to a decade ago. And the more sobering news is there's a lot of progress that the world collectively agreed should happen by 2015...and it just doesn't look like much of it is going to happen.

The CDC released U.S.-specific figures earlier this week. What did you find was most interesting about those figures?

Cohen: At a big-picture level, the fact that they're focusing on youth is in itself the real message. And the message that they're putting out is that young people -- which they define very broadly, from 13 to 24 -- account for one-fourth of the new infections. And about 60 percent of the people in that age bracket who are infected don't know their status....You can't help people who are infected unless they know that they're infected.

... The other major theme in this CDC report -- there's a lot of talk of the spread of HIV among men who have sex with men. That's where the epidemic is in the United States. It's among young, black, gay men. That's the real root of the problem. One of the trickier questions to answer is why. Why is this population so vulnerable? It turns out their behavior isn't that different from other groups in terms of number of sexual partners, condom use or risk factors like drug and alcohol use. But one thing that is markedly different is these men tend to have sex with black men. The population that they're in has a high prevalence that makes it much more likely that they'll contract the virus. And in many cases, HIV is being transmitted from older men to younger men, which is a great risk factor in and of itself. If you're older, you're more likely to become infected. It seems obvious, but a lot of young people don't think that through.

Does the CDC have a new plan for addressing this?

Cohen: Yes, they have a plan, but it's the same plan that they've been pursuing. I think that the real limiting factor here is that...states determine how they educate kids -- that's where the kids are getting their messages. The health care systems in individual states differ dramatically. And a lot of kids at highest risk have the least access to health care. So it's a really complicated problem.

Coming out of the International AIDS Conference in July, we were hearing a lot about treatment as prevention. Treat infected individuals as early as possible, suppress the virus in their systems and they'll be far less likely to spread the disease, even if they engage in risky behavior. Is there still so much buzz around that idea?

Cohen: Sure. You're going to hear more and more about it over the next years as we see actual progress in communities that roll out massive treatment. It works. The problem is that a lot of people that start treatment don't do it properly and they don't fully suppress their virus. If you don't fully suppress your virus, you're not going to get the bang for the buck in terms of treatment as prevention.

There's something called the treatment cascade. What the CDC and other groups have shown is about 20 percent of the people in the United States don't know their HIV status, about 20 percent of the people who learn their status will never hook up with a health care provider, 20 percent who do hook up with a health care provider never start drugs and 20 percent who start drugs don't take them properly. So there's a cascade of problems all along the way and it's a cascade that's even more pronounced in youth. Until that is addressed more aggressively, the real treatment as prevention benefit isn't going to be realized....The solution is finding a way to help people who have many problems to take drugs every day for the rest of their lives.

Are there places in the world where this seems to be working particularly well?

Cohen: The hardest-hit places in the world, like South Africa, have more HIV infected people, a higher burden than anywhere: 5.7 million HIV-infected people within the total of 34 million in the world. And I think treatment as prevention in South Africa is more promising than anywhere. The problem -- and this came out of the CDC report -- the problem isn't simply that people are taking more risks. In a place like South Africa, the odds of you partnering with someone who is infected are much higher than the odds of you partnering with someone who is infected in the United States, especially if you're a heterosexual. If it's a Russian roulette, there are more bullets in the gun. So treatment as prevention can probably have the most dramatic impact in the places that are hardest hit.

We've also heard a lot recently about universal testing. What's behind this recent push?

Cohen: The fact remains that many people in the world who are infected don't know their status, so there's a lot of effort to make testing routine and not have it be something that's an exceptional thing. There are a lot of emergency rooms now in the United States that offer treatment to everyone who comes in, regardless of what they're coming in for. You can come in for a broken arm and you'll still get the test. It's being done in some places as an opt-out policy, which means that everyone's going to receive an HIV test unless they say they don't want it. That's completely different than in the old days when it was a big deal to get an HIV test.

If the universal testing approach achieves its goal -- everyone is tested and a lot more people who are HIV-positive are diagnosed -- where would the extra money come from to to treat everyone?

Cohen: One of the things that the UNAIDS report highlights is that there's been a plateauing of funding coming from wealthy countries, but a lot of hard-hit countries are increasing their domestic spending. That's where the bulk of new funding is coming from. So I think South Africa, again, is an excellent example. It's a country that a few years ago set out to test 15 million people in its population of 50 million. And it just poured a ton of new money into its own HIV/AIDS prevention and care budget. The money's going to have to come more and more from these countries.

There's an Abuja Declaration that was signed many years ago by developing countries, that they would spend at least 15 percent of their GDP on health care, and many countries haven't lived up to that commitment, and so the wealthy world, and indeed the middle-income and low-income countries that are living up to that commitment, are now looking more critically at the countries that haven't.

Is there any talk of the United States increasing funding for this?

Cohen: In terms of the United States, there's a push to do what is called a "Robin Hood Tax," which is to put a tax on all electronic financial transactions, and it's been lobbied for a few years now. I don't know that it's had much traction. But that could introduce new money. I can't imagine that the U.S. Congress, given the country's budget woes, is going to launch a massive new program to do anything internationally in terms of HIV and AIDS. It might, but it doesn't seem like that's going to happen. The U.S. is the biggest donor to the Global Fund and is also independently doing the PEPFAR program (President's Emergency Plan for AIDS Relief) to bring drugs and prevention to countries around the world.

So I think the real question is to look at other wealthy countries. The U.S. is leading the way. And I don't mean to sound like a booster, because I'm just looking at it critically. I think the U.S. is doing its fair share and there are other wealthy countries in Europe that are not....One of things that stood out to me a couple years ago at the International AIDS Conference was that is was held in Vienna, Austria, and Austria doesn't contribute much of anything to the Global Fund to Fight AIDS, Tuberculosis and Malaria. I think you have to look critically at Russia, as well, and what is it contributing? I think there are several Middle Eastern countries that are very well off that aren't contributing much. I think Saudi Arabia is an exception....

This is one of the actual Kumbaya things that the world has accomplished. The creation of the Global Fund is a revolutionary idea that basically came out of nowhere in 2002 and has provided treatment to half the people in the world who are getting treatment today who are in resource-limited places. It's a magnificent accomplishment and it's been done by the world saying collectively, 'We can do something with our money to solve a problem." But the fund has to be replenished constantly.

And we also have to look more critically at what it means to be a middle-income country. There are more and more low-income countries that are moving into middle-income status and there's a World Bank report that came out last year that says that more countries are moving up the ladder and I think the wealthier world wants those countries to pull their weight.

Let's talk a bit about prevention. Where does research for a vaccine stand?

Cohen: That's still the dream. I mean, if you could go get three shots and never have much of a risk of HIV, that would be the ideal way to bring the epidemic to a screeching halt. And certainly, it's worked with lots of other infectious diseases, where in a very short time, we've derailed epidemics. The polio epidemic, for example. That came out in 1955 and by 1961, that epidemic had been ground to a halt in the United States. The vaccine was only used by 70 percent of the people and the vaccine was only 70 percent efficacious. So you can you can get a lot of mileage out of a vaccine.

Where we stand with an HIV vaccine is that this is a very hard vaccine to make and we know that because so many smart people have tried, so many companies have tried, so much money has gone into this and there is no candidate vaccine on the horizon that looks all that promising. The basic research is progressing and there's been a lot of advances made in trying to find the proper antibody response. Antibody is just one immune response that can stop a virus but it's an important one and that's been a very hard thing to find with HIV vaccines -- a vaccine that actually triggers the immune system to produce an antibody that works against many, many strains of the virus....We have the target, we just don't know how to get there.

Are there any other interesting studies out there that you you're keeping an eye on at the moment?

Cohen: This stuff moves in fits and starts. Right now, the low-hanging fruit have all been picked. All the easy answers are there. So now the questions that remain are incredibly complicated questions. How do you cure someone who is infected? That remains another dream, just like the vaccine. One person has been cured. But the way he was cured isn't applicable at large. He had leukemia and had his immune system basically eradicated and a new immune system put in. That's not practical at all. So the basic research that's going into a cure and into vaccines is really the most exciting stuff and it's defined by serendipity. It's defined by people stumbling upon things that they weren't necessarily even looking for. So there's no way to predict what's going to come out of that.

In terms of large clinical trials of drugs, we're way passed that era. There are loads of good drugs on the market. And in terms of proving that drugs prevent infection, we know that. There's still a dream for a microbicide that women can use -- a vaginal gel that stops HIV. And I think that we'll see progress there.

I also think that we'll see progress with people starting to use antiretrovirals in uninfected people. We know that pre-exposure prophylaxis works. Studies have shown that that works. It's not used in many places, but it certainly can protect people.

Finally, people use World AIDS Day to take stock of where we are with all of this. What would be your summary for this year?

Cohen: I think that all these disease days are a marketing campaign by the World Health Organization and other public health institutions. They don't have a lot of meaning unless something has really changed dramatically in that time period. In this past year, the big shift and the big insight didn't happen in the past few weeks. It happened six months ago, 12 months ago, where there became a mantra where we really now have the tools to end AIDS epidemics in specific locales with all the prevention modalities that have proven themselves....

Frankly, I think that there is a bit of reluctance to speak honestly about the challenges that remain because they're so daunting. A lot of what these disease health days are trying to do is to convince donors to keep funding and solve the problem. So they, of course, want to highlight progress because they want donors to know that they're getting their bang for their buck. And it's true, they are. Progress is being made. It's not a fiction. But when you balance it against the things that haven't happened and the reluctance of many countries to do the right thing, to do the scientific thing, it's a very difficult thing for organizations like the United Nations, which is made up of member states, to come out and critically point fingers and say, "These countries are failing and here's why.' They try to, and if you read between the lines to find the information, it's there. But it's not as blunt as journalists would like it to be and I think that's part of our job, to highlight that Russia has a huge injection drug use problem and outlaws methodone, which has been shown to work in country after country to get people off injecting opioids. So why isn't that front and center highlighted and hammered in again and again? It's just politically dicey.

I think that the one thing that the world can dance in the streets about right now is how much progress is made with slowing mother to child transmission. It's pretty easy to stop HIV from moving between an infected mother and her baby and there's a whole health care infrastructure that's set up for pregnant women. Places that take advantage of the medication that exists basically don't have transmission from mother to children. That's just something that has had a major impact in the world and that's one goal that's attainable if there could just be more of a concerted effort to take advantage of what we know and to highlight the places that aren't doing it and to shame them. It does require a certain amount of shame, but it's possible.

Jon Cohen discussed the CDC's latest Vital Signs report about HIV/AIDS among youth with Hari Sreenivasan on Tuesday's PBS NewsHour. Watch the full interview here.

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Promoting Safe Sex With Posters on World AIDS Day

Fri, 30 Nov 2012 07:16:00 EDT

Courtesy of University of Rochester.

World AIDS Day is Dec. 1, a day devoted to the fight against HIV and for showing support for those living with the virus. It also is a day that has been used to raise awareness for prevention and better knowledge about AIDS.

Last year, NewsHour profiled Dr. Edward Atwater's extensive collection of AIDS outreach posters, the majority of which were created in the 1980s and 90s. Here is the original video from 2011:

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Originally developed for public health campaigns to promote HIV testing, safe sex, and better knowledge of the virus and disease, Dr. Atwater began collecting the posters for their social and cultural importance. After years of collecting from all over the world, he donated all the posters to the University of Rochester.

The complete collection contains more that 6,200 posters, from all over the world and in a variety of languages.

Here's a sample of posters selected from the Atwater AIDS Education Poster Collection:

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Since World AIDS Day 2011, the university's archives have continued to develop a digital library of the Atwater collection, adding more than 1,000 posters to an online archive that is accessible to the public free of charge. Since the digitizing process began, 2,460 are available to view online.

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Health Care Workers Brace for New Cholera Outbreaks in Haiti

Fri, 02 Nov 2012 16:30:00 EDT

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PORT-AU-PRINCE, Haiti -- Hurricane Sandy might have saved its fullest fury for America's mid-Atlantic coast, but its earlier blows in the Caribbean wreaked havoc in Haiti.

Already struggling to recover from the effects of Hurricane Isaac in August, which in turn set back rebuilding from the earthquake of January 2010, Haiti now faces renewed crises on multiple fronts.

"The economy took a huge hit," Prime Minister Laurent Lamothe told the Reuters news agency. "Most of the agricultural crops that were left from Hurricane Isaac were destroyed during Sandy, so food security will be an issue."

In Haiti, at least 54 people died from the hurricane. Much of the damage from Sandy occurred in the rural south of this nation of 9 million. Subsistence farmers saw both crops and reserves wiped out by three days of torrential rains, something the government fears could once again trigger a spike in food prices and the widespread social unrest that has usually followed it in recent years.

In Haiti's capital Port-au-Prince, where hundreds of thousands of earthquake victims remain displaced in crowded tent camps, health care workers are bracing for a resurgence of cholera.

A child is treated in a cholera ward at San Luc Hospital in Tabarre, just outside Port-au-Prince, Haiti. Photo by Nicole See for the NewsHour.

Haiti's cholera epidemic began two years ago. The bacterium is spread by fecal-oral contact. The epidemic was most likely caused by sewage discharged from a camp housing U.N. peacekeeping soldiers from Nepal into the Artibonite River, a source of drinking water for many Haitians who have no access to treated water.

Cholera had not been seen here in almost a century, and it blindsided health workers as much as its terrified patients.

"We didn't know the first thing about cholera except what we could Google," said Rick Frechette, a Catholic priest and physician recalled from those early days almost exactly two years ago.

To date, cholera, which causes severe diarrhea and fluid loss, has killed nearly 7,500 Haitians and sickened another 600,000. Now, floodwaters from Sandy have again churned up the cholera bug, contaminating drinking water supplies and further hindering access for many -- especially those in tent camps and remote areas -- to safe sources of water and sanitation. The government has reported eight suspected cholera deaths post-Sandy.

At treatment centers, admissions have spiked. They've doubled at San Luc Hospital on the city's northern outskirts, which has treated 36,000 patients since 2010.

The hospital took in about 20 new patients each day in October until Oct. 26, the day Sandy's impact peaked here. There have been nearly 40 daily admissions ever since. Fortunately, most will make a full recovery.

With massive publicity campaigns on billboards, radio and television, most people are aware of cholera's symptoms, so patients are brought in much earlier for care. Cholera is easily treated with antibiotics if they are administered early. As a result, mortality rates are now less than 1 percent, well below what they were two years ago.

Still, the fact that so many come down with cholera despite the awareness might be an indicator that safe water and sanitation remain elusive to many people.

The new epidemic might be less deadly than the first one, but it's both a distraction from and a proxy for the enormous task post-quake Haiti faces to rebuild itself virtually from scratch.

Related Resource: More reports from Haiti, two years after the earthquake

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Haiti Battles Hurricane Sandy and Cholera

Fri, 02 Nov 2012 15:50:00 EDT

More than 50 people have died in Haiti from Hurricane Sandy, which hit the Caribbean island in late October, washing away crops and threatening to worsen a cholera epidemic.

River Swells

Heavy rains from Hurricane Sandy causes the Croix de Mission river to swell to levels that threaten to flood the homes along its bank in Port-au-Prince on Oct. 25. Photo: Swoan Parker/Reuters

Flooded Tents

Haitians walk through mud after rains from Hurricane Sandy flooded their tent encampment in Port-au-Prince on Oct. 26. Sandy also affected houses that were under repair, said the International Rescue Committee's Haiti Country Director Miriam Castaneda. Overall, according to government estimates, more than 18,000 households were damaged by the storm, she said. Photo: Swoan Parker/Reuters

Falling Palm

A coconut tree in Haiti's capital Port-au-Prince falls and is washed away by rains from Hurricane Sandy on Oct. 26. Photo: Swoan Parker/Reuters

Waist-high Water

Haitians walk through a street flooded by rains in Port-au-Prince. Hurricane Sandy caused an estimated $300 million in damages, more than last year's Hurricane Irene. Photo: Swoan Parker/Reuters

More Than Showers

A Haitian woman dons a shower cap as Hurricane Sandy douses the Caribbean island in late October. Photo: Swoan Parker/Reuters

Bailing Out

A Haitian woman scoops mud out of her flooded tent home in Port-au-Prince. It's taking awhile for the tents to dry, because rains continue during the evenings, said the International Rescue Committee's Haiti Country Director Miriam Castaneda. "There is a lot of debris and garbage that still needs to be collected and some people have taken to the streets to clean. " Photo: Swoan Parker/Reuters

Staying Dry

A boy uses oversized rain boots to try to keep dry in the storm. Photo: Swoan Parker/Reuters

Cholera Treatment

Patients diagnosed with cholera receive treatment at a medical center run by Medecins Sans Frontieres (Doctors Without Borders) outside of Port-au-Prince on Nov. 1. Photo: Swoan Parker/Reuters

Haiti's Epidemic

A child is treated in the cholera ward at San Luc Hospital in Tabarre, just outside Port-au-Prince. Haiti's cholera epidemic began two years ago. The bacterium is spread by fecal-oral contact. Photo: Nicole See/NewsHour

Cases Increase

Doctors Without Borders reported an increase in the number of patients being admitted to its hospital outside Port-au-Prince since Hurricane Sandy tore through the Caribbean nation at the end of October. Photo: Swoan Parker/Reuters

Food and Health

A girl gets a bath while receiving treatment for cholera. Haiti is facing food shortages, because of disruptions in agriculture production due to the storm, and the spread of illness from the flooding, according to U.N. humanitarian officials. Photo: Swoan Parker/Reuters

China's Chances of Kicking a Growing Smoking Habit

Wed, 31 Oct 2012 14:47:00 EDT

When China's top politicians gather early next month to pick the country's new leaders, one issue likely to be missing from the agenda is the single largest killer of Chinese people -- their smoking habit.

As with any issue in China, the numbers on tobacco, cigarettes and smoking are daunting: More than a trillion cigarettes produced by the state tobacco monopoly; more than 300 million smokers, 740 million second-hand smokers, and, by 2020, some two million annual deaths related to smoking.

These are numbers the NewsHour has been chronicling since Ray Suarez reported from China two years ago:

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Two days after Americans pick their president, China's 18th Communist Party Congress opens to ratify the choice of a new party leader and premier to replace the current leaders Hu Jintao and Wen Jiabao. And there is one feature that sets this group of politicians apart from the early leaders of China -- none of the current members of the most powerful body, the Standing Committee of the Politburo, are smokers and only five in the current 25-member Politburo.

Whether the change of personalities at the top will affect the lives of masses of Chinese smokers was the topic of a recent conference at the Brookings Institution that drew a cluster of China and public health policy wonks. For the conference, Brookings published a new book, The Political Mapping of China's Tobacco Industry and Anti-Smoking Campaign by political scientist and senior fellow Cheng Li.

Li and other participants painted a mixed picture of China's anti-smoking measures and whether the government is ready to take on the tobacco state monopoly, which last year generated nearly $120 billion in revenue and turned $95 billion over to the government. Marketing of cigarettes is slick and effective, said Yang Gonghuan, former deputy director of China's Center for Disease Control and Prevention, and who was featured in Ray's report. Cheaper brands sell for less than a dollar, and advertising suggests low-tar cigarettes are less harmful.

Guonghuan expressed hope the new leadership would make smoking not only a public health issue but one of economics and international politics, as well. For instance, Chinese have a 10-year shorter life span than citizens of the other G20 nations, and 260 million Chinese suffer expensive chronic illnesses caused by smoking. She and other anti-smoking advocates are pressing for the government to implement the international pact it signed several years ago to curb smoking. While smoking has been officially banned in public places, it remains omnipresent, she said.

On the plus side, according to Li and Guonghuan, is the fact that the wife of Xi Jinping, the anticipated new party leader, is among the celebrity figures (she is a popular singer) serving as anti-smoking ambassadors. The country has the capacity to react to public health crises, even if belatedly, as it showed in the SARS epidemic in 2003. The government has taken up other public health issues, such as the annual appearance of the premier with HIV/AIDS victims.

On the down side, smokers in China are overwhelmingly male, and the tobacco industry could determine there is a major new market to be exploited among younger women. The Public Health Ministry remains weak, and some top party leaders overseeing public health bureaucracies come out of the tobacco industry. And the Chinese monopoly, unlike its counterpart in India, shows no sign of diversifying into other businesses.

Perhaps the biggest obstacle to any immediate results from the Party Congress: The leaders will have some overwhelming issues to tackle -- an economic slowdown, simmering disputes with Asian neighbors and allegations of corruption at the highest levels -- in a meeting already postponed beyond the normal starting date.

A more realistic prediction, conference participants said, was that the government might take some new steps in the months after the party congress.

Michael D. Mosettig, PBS NewsHour foreign affairs and defense editor emeritus, watches wonks push policy in Washington's multitude of think tanks. From time to time, he writes dispatches on what those scholars and wannabe secretaries of state have in mind for Europe, Asia and Latin America. Top photo by Ed Jones/AFP/GettyImages.

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As Diets Change in Greece, Obesity Becomes Growing Problem

Mon, 29 Oct 2012 12:45:00 EDT

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In the next installment of the "Food for 9 Billion" series, Jon Miller of Homelands Productions examines how Greece has come to have one of the world's highest obesity rates despite a native diet that is extremely healthy. It stands as an example of the diet transition that occurs as economies modernize and urbanize.

By Jon Miller of Homelands Productions

The U.N. estimates that more than 10 percent -- some 870 million people -- of the world's population is chronically malnourished. Yet the number of overweight people is even higher -- about 1.4 billion. Over the last 30 years, the global obesity rate has doubled.

To find out why, I traveled to the island of Crete, in southern Greece. I've been reporting around the world for more than 20 years, and I have to admit -- I've had tougher assignments.

I really like Greek food: the fresh vegetables, the olive oil, the herbs, the yogurt, the wine. And lucky me -- since the 1950s, study after study has shown that the Mediterranean diet, and especially the diet of Crete, makes you live longer, protects you from heart disease and cancer, and keeps you from getting too fat. Look at lists of the world's healthiest diets, and the one from Crete often ranks at the top.

Unfortunately, hardly anybody follows it anymore.

I met a 16 year old I'll call Eleni with her mother in Chania, a port city of about 50,000 in western Crete. Eleni's grandparents lived in the countryside, but she and her parents grew up in town. Her favorite musician is Justin Bieber. Her favorite foods are hamburgers and pizza.

Eleni has struggled with her weight most of her life. She's been up to about 200 pounds. Schoolmates have taunted her. Her mother told me she tries to lose weight, but then she lapses.

"Sometime she eats a lot," she said. "And she eats everything; whatever you can imagine. But other times she's OK. I don't know. That's the problem."

She thinks her daughter's weight issues have to do with lack of discipline and low self-esteem. But clearly there's something bigger going on. Today Greece has the one of the highest obesity rates in the world. The proportion of overweight children -- about 40 percent -- might be the highest, except for some Pacific islands. The problem's especially bad in Crete, home to what could be the world's healthiest diet. So what gives?

"It has to do with many factors," said Christina Makratzaki, a local dietitian who also battled obesity as a teenager. We met at a waterfront cafe full of European tourists.

"In the '50s and '60s the people, they were poor, but they were healthy," she explained. "They were eating very good foods -- the olive oil, the olives, the green leafy vegetables that are our treasure. But they were enforced in a way because of their poverty to use these things."

Then people here got a little money -- from tourism, from agriculture -- and everything changed.

"Now, we have many choices," she said.

Like processed food from the supermarket and fast food on the street; and soda and doughnuts and ice cream. All of it cheaper to buy, easier to prepare -- and, especially for children, harder to resist -- than what grandma used to make. And then there's the marketing -- a relentless bombardment of ads aimed at kids for products like soft drinks and breakfast cereal and processed meat.

Before I left for Crete I spoke with Marion Nestle, a nutritionist at New York University whose books include "What to Eat" and "Why Calories Count." "World trade has opened up a world marketplace in food that's like nothing the world had never seen before," she said. She told me nearly every society is going through what Crete has gone through -- even in places where hunger is still endemic. It's known as "the nutrition transition."

"The nutrition transition happens very quickly," she said. "As soon as people get money, they start buying more meat and more processed foods. Well, that's fine if you don't eat too much of it. The problem is that we as humans, when we're confronted with large amounts of delicious food, we eat large amounts of food."

There is some disagreement among nutrition experts on the exact causes of obesity. Nestle believes it is mainly a question of "calories in and calories out" -- if we eat too much and exercise too little, we're bound to get fat. Others think the types of things we eat matter more than the amount; for instance, simple carbohydrates encourage us to eat more and retain more fat than other foods. (The traditional Cretan diet is high in fat, mostly from olive oil, yet people who adhere to it rarely became obese.) Some recent research suggests that changes in our intestinal bacteria may play an important role.

The word "diet" actually comes from the Greek -- it originally meant "way of life." And clearly obesity has to do with more than just what people eat.

It typically starts with the upper classes, who do less physical work and can afford to buy more fattening food. For a while, being plump is a sign of wealth and health. But then, in most places, there's a shift. People with money start to value thinness. At the same time, farmers move into the cities, women join the work force and have less time to cook, machines replace manual labor, kids watch more TV and packaged food becomes cheaper than fresh food. Pretty soon you have an epidemic, with the worst effects felt among those with lower incomes.

"Health officials and policy makers are realizing what the costs of obesity are likely to be not only to the individuals themselves but to the society," Nestle said. "The question is what to do about it. People are trying lots of different things, and more power to them. But nobody really has an answer."

The dietitian Christina Makratzaki showed me some of the things people are trying in Crete. A burger chain has started serving things like freshly squeezed juice and turkey wraps. The canteen at the local bus station is offering traditional Cretan dishes, bathed in olive oil. The association of school snack bar operators has told its members to cut out the sweets and sodas at the kiosks they rent, and most have complied.

But all those things are voluntary. To find out what the government's up to, Makratzaki and I dropped in on the mayor of Chania, Emmanouil Skoulakis. He is a doctor who served several terms as Greece's deputy minister of health.

It had been a rough week. On the day we met, the city's workers were on strike. The day before that it was the teachers. Skoulakis said the obesity crisis was of great personal interest to him -- that was why he was willing to see me.

He told me the city sponsors exercise programs and a local food festival, where people could talk with chefs and sample traditional cuisine. Last spring it helped organize visits by 14 dietitians to some of the schools. But money is tight. Beyond rallying volunteers, he said, there's not much the government can do.

That's especially true now, with Greece in crisis. Unemployment is 25 percent and people are marching in the streets. I asked everyone I met if they thought the economic troubles may have a silver lining, sending people back to the old ways, eating fruits and vegetables and dessert just on Sundays. They all shook their heads. With junk food so much cheaper than fresh food, they say, the lighter people's wallets, the heavier they'll get.

The "Food for 9 Billion" series is a NewsHour collaboration with the Center for Investigative Reporting, American Public Media's Marketplace and Homelands Productions.

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In Africa, MTV Series 'Shuga' Promotes HIV Prevention Among Youth

Fri, 05 Oct 2012 11:44:00 EDT

"Shuga" follows the lives of six young adults and the challenges they face. Photo by MTV Base

Love. Sex. Money.

This is the stuff that hit television shows are made of. Add stellar production, a good-looking cast, a strong plot and a setting in a cosmopolitan city -- namely Nairobi -- and you get "Shuga: Love, Sex and Money," the MTV Base show that took the African continent by storm.

Wrapped in bright lights and dramatic storylines, the show is nonetheless able to weave in messages of sexual health and keep to its goal of promoting HIV prevention among African youth.

The show, which launched on World AIDS Day in 2009, first came together through a partnership between the U.S. President's Emergency Plan For AIDS Relief (PEPFAR), MTV Staying Alive Foundation, the Partnership for an HIV-Free Generation and the Kenyan government. It has since been seen not only in Kenya but in 22 African countries, and 70 countries worldwide.

Lydia Murimi, the Kenya Director of the Partnership for an HIV-Free Generation, gives us an introduction to the basis of the show.

Watch Video

CONTROVERSY OR FACT?

Many of the HIV prevention topics covered in the show are aligned with the agenda of the Kenyan government, including HIV testing and avoiding stigma.

However, there are a number of subjects covered, from sexual violence to homosexuality -- part of the dialogue surrounding HIV prevention and sexuality -- that are never shown on Kenyan television and are taboo public discussions. Thus, the success of the show has come from its ability to push boundaries in its message, as well as what can be shown on TV in Kenya.

Homosexuality is illegal in more than 30 other countries in Africa, according to Reuters, which reports that few Africans are openly gay.

"It was interesting bringing the topic of homosexuality to the table, particularly with the government of Kenya and a mix of generations in the same room," Lydia Murimi, Kenya Director of the Partnership for an HIV-Free Generation, said of the discussions about production for "Shuga."

Seeing that gay Africans are a demographic that needs to be included in the discussion of AIDS prevention, it was a difficult topic to ignore, however controversial it may have been. After their negotiations, they chose to cover a specific area of homosexuality, focusing specifically on married men who maintain both homosexual and heterosexual relationships.

"The older generation did not really react," Murimi said of the subtle inclusion of homosexuality in the show once it aired. "But the youth commended us for it because it reflects with what is happening on the ground.

"In Kenya, we are the only ones telling that story."

Murimi discusses how pushing boundaries has always been a key philosophy of the show.

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WHAT ARE THE YOUTH RESPONDING TO?

Since the collaborative partners chose to align their messaging strategy with that of the Kenyan government, none of the topics covered, from avoiding stigma to testing, are necessarily new or different when it comes to promoting prevention of the virus.

Yet the target age group, 15 to 24-year-olds, are responding to "Shuga" and its messages in a way that no other HIV prevention initiative in Africa has.

"'Shuga' appeals to youth by hosting their dreams, reality and future on screen," Josephine Karianjahi, 25, said at a packed screening of the show's second season, during the 2012 International AIDS Conference in Washington, D.C.

"While HIV/AIDS may be removed from day-to-day life for many, the personalization of the show make it extremely necessary in the fight," she said.

Since the premiere of the second season in February 2012, the show has reached 75 percent of its target audience in Kenya alone, Murimi stated.

In this video, Murimi discusses how African youth relate to the show.

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Soon after the first season in 2009, Johns Hopkins University conducted a study designed to measure the intent to change behaviors after watching the show. Through exit interviews, the researchers concluded that 80 percent of those who saw "Shuga" believed it changed their thinking about having multiple concurrent partners, HIV testing and stigma associated with HIV.

Another study was conducted after the second season ended that examined if there had been actual behavioral change, and not just an intent to change. Results for that study are expected in 2013.

"We are stepping that up and really want to demonstrate behavior change," Murimi said.

Murimi discusses the impact of "Shuga" even once each season is done.

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ADVICE FOR ADVOCATING TO THE YOUTH

The young adult demographic that the show is aimed to reach have been involved in all areas of production of the show, an element that Murimi says is key to its success in reaching and impacting them.

"This generation are dreamers, but they can make things happen," she said. "They are very worldly; the world is a village now. They are very in-tune with what is happening in the world, and they digest so much information."

In this video, she offers ideas on how to reach their target demographic.

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Her advice will likely be key in moving forward with the project, as ideas for more seasons of the show are in discussion.

"There is interest in Nigeria, Botswana and other African countries, because they want us to tell their own stories," Murimi said. "Now it's about, how do we factor in other countries outside of Kenya?"

Videos were shot by Paula Rogo and Cindy Huang. They were edited and produced by Paula Rogo.

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In 'Half the Sky,' Transforming Limitations on Women's Opportunities Worldwide

Mon, 01 Oct 2012 18:43:00 EDT

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JEFFREY BROWN: And finally tonight: A new PBS documentary shines a light on the oppression of women and girls worldwide. "Half the Sky" airs in two parts over two nights, starting this evening. It's based on a book of the same name by New York Times columnist Nicholas Kristof and his wife, journalist Sheryl WuDunn.

Kristof traveled to six countries to look at gender-based violence, forced prostitution, maternal mortality, and other issues.

In this excerpt, he and actress Eva Mendes tour a sexual abuse victims center in Sierra Leone.

WOMAN: Welcome to the Rainbo Centre. Really, we're primarily responding to rape. We provide specialized medical treatment and counseling as well.

EVA MENDES, Actress: Counseling? Yes.

WOMAN: We have seen over 9,000 survivors within eight years.

EVA MENDES: Eight years.

WOMAN: Fifty-two percent that are between the ages of 12 and 17. Then you have about 26 percent that are under 12.

NICHOLAS KRISTOF, The New York Times: Under 12? Twenty-six percent are under 12?

WOMAN: That are under 12 years old, yes.

NICHOLAS KRISTOF: OK. Wow.

WOMAN: They are.

The trend is, we are seeing more and more children, about 80 percent of our clientele.

We see an average between 100 to 200 a month. And they are as young as two-and-a-half months old.

Excuse me. Sorry. We have a three-year-old that has just come in for follow-up.

NICHOLAS KRISTOF: Yes. It's a 3-year-old...

WOMAN: It's a 3-year-old girl who has been raped. And she's just come back for follow-up. Yes. You want to come with me?

NICHOLAS KRISTOF: Yes.

What is her story, very briefly?

WOMAN: She's actually -- they don't know who the perpetrator is. But she was getting sick. And they took her into the hospital.

And that's when it was realized that she has been abused, because they have not been to see who it -- know who it is.

EVA MENDES: You can't even fathom like how -- how somebody could even just hurt a child, but how they can commit such an aggressive sexual act against them.

WOMAN: This is Jessica.

NICHOLAS KRISTOF: Hey, Jessica.

EVA MENDES: Hi, Jessica.

How you can rape a child is beyond...

Hey. It's magic.

WOMAN: So, Jessica is doing much better now.

EVA MENDES: I mean, why? Why?

JUDY WOODRUFF: Joining me now from New York are husband and wife team and "Half the Sky" co-authors Nicholas Kristof and Sheryl WuDunn.

For more than two decades, they have been working to draw attention to neglected issues and areas of the world.

And we welcome you both.

And, Nick, we just saw you in that clip from Sierra Leone. It's just an unimaginable situation.

NICHOLAS KRISTOF: But, in many ways, Judy, it's really the face of modern conflict.

It's what happens these days in civil wars that militias and warlords don't want to tangle with each other because they might actually get shot.

So, they turn their AK-47s on local women, and women's bodies become modern weapons of war.

And then, even when the conflict ends, the militias stop shooting other people, but this kind of rape, including of young children, continues. We have seen that in place after place after place.

JUDY WOODRUFF: But why -- Nick, why are women the victims?

NICHOLAS KRISTOF: I think because people can get away with it, in a sense, because they don't fight back.

If you're a former of a militia and you still have your gun or you still have that kind of violent mentality, then if you set up a checkpoint on the highway and rob a truck, you will be caught and you will be executed.

And that's a priority for the government.

If you go around raping young girls, that's not a priority for the government and you don't get prosecuted and nothing happens.

JUDY WOODRUFF: Sheryl...

SHERYL WUDUNN, co-Author of "Half the Sky": But, at the same time, you terrorize a village.

JUDY WOODRUFF: That's right.

Sheryl, I was going to ask you about that and about, how widespread is this beyond Sierra Leone?

SHERYL WUDUNN: It's actually more widespread than anybody would like.

And it is a weapon of terrorism.

It is a way to actually make a statement that also terrorizes an entire community. Everybody has girls and women in their family. And so those people who are -- whose women are afflicted are -- are terrorized.

JUDY WOODRUFF: So, we're talking about across the developing world. Sheryl, why is it tolerated?

SHERYL WUDUNN: Well, I think that it's not so much tolerated as it is just -- it's just people bear it.

They endure it, partly because there are no super-organizations, governments, large NGOs, other governments, who are stepping in to try and help or fix, remove the situation.

And I think it's an issue that people in general don't seem to care enough about to bring about change. And so if there is a way that we can say that everybody here in the world says that this is not something that should be tolerated, then I think people will take steps to eradicate it.

JUDY WOODRUFF: Well, Nick, in that connection, I think, in Sierra Leone, you talked to one investigator who had looked at, what, over 1,000 cases, but in all of those cases there was only one conviction? How can that be?

NICHOLAS KRISTOF: Well, because it simply is not a priority for the government.

And this is something that one can bring about change in. And, you know, we have seen it in Congo. We have see this in Sudan that, when there become penalties, then patterns change.

I mean, I -- we have that in sex trafficking around the world, that if authorities go after pimps, then all of a sudden it becomes less lucrative, less attractive to be a pimp.

And so there are no magic bullets here, but one thing we can do is apply pressure to help raise this issue on the agenda. And if, instead of one-tenth of 1 percent of rapes being prosecuted in Sierra Leone, if it rises to 10 percent, that will send a powerful message through the community and it will lead to change.

I mean, one example, in the case of Sierra Leone, is it used to have the worst maternal mortality rate in the world. And then that got attention. Sierra Leone was embarrassed. And now delivery is free in Sierra Leone, and the maternal mortality rate has dropped by more than half.

SHERYL WUDUNN: It's also important to see that women can actually become part of the solution.

So if they can actually be empowered economically, then look at all that potential economic income that can be brought into a household.

JUDY WOODRUFF: And that's what I wanted to ask you about, Sheryl, because I think one of the focuses that you describe is turning oppression into opportunity. And I wanted to ask you, how do you do that?

SHERYL WUDUNN: There are many ways.

First of all, the government has to say it is very important for the populace to be educated.

So they need to mandate education for everybody, including girls. And then they have to say, well, it's also that we allow our women to work in the workplace, to actually become productive members of society.

And once you give a woman education and a chance to work, she can astound you.

JUDY WOODRUFF: Sheryl, I want to ask both of you, for people who are sitting at home watching this on their television or their computer, what can they do about this?

NICHOLAS KRISTOF: We have website, halftheskymovement.org. And we have an action tab there.

So our hope is that people are going to watch the documentary on PBS, and then they're going to go to that halftheskymovement.org website and then they're going to do something. And it may be make a donation or engage with some organization or volunteer their time or write a letter.

But, I mean, the ultimate metric of success for this documentary isn't the number of people watching it. It's the number of people who then take action and get involved.

SHERYL WUDUNN: Even spreading the word is really important, because the more people who see that this is an issue, the more people who begin to care about this as an issue.

Then, the governments start to realize that this is something that voters care about. And they will actually vote for policy changes, which is also very, very important.

JUDY WOODRUFF: Yes, I wanted to ask you all about this, because, you know, in many ways people look at these scenes. And while it certainly tears at your heartstrings, you think it's so far away, am I really connected to this?

NICHOLAS KRISTOF: I mean, I guess there are a couple of answers to that.

One is that there are real needs we need to address right here at moment. And, sure, sex trafficking is worse in India or Cambodia than it is in New York or Washington.

But we have problems here. And if we want to have the moral authority to tell other countries to clean up their act, we have to do more right here at home.

But the other thing is that I don't think -- there's one view that we really need to solve our problems at home before we begin to address problems abroad.

And I think the policy there is first that interventions abroad often get more bang for the buck than those here, that it is very cheap to save a life abroad, and, second, that our compassion and our empathy shouldn't depend on the color of somebody's skin or the color of their passport.

JUDY WOODRUFF: Sheryl, do you want to add anything to that about why people should feel connected to this?

SHERYL WUDUNN: Well, I also think that there are many things that we can learn, not only from policies and programs that we have implemented here at home, but also abroad.

There's a lot of learning that we actually are garnering from programs that have been established abroad to attract -- to address trafficking, because it is a problem that started abroad, that was much more of an issue abroad before it came to our own shores. So, they have had a longer history.

Also, in a place like Sweden, there is great deal of learning in the way they have actually tried to eradicate trafficking. They have been much more successful than other societies in focusing on demand, on the johns. And we can learn from them as well.

So, I really think it is a globalized world. We need to actually look at this as a global problem.

JUDY WOODRUFF: Well, we thank you both for helping us understand more about it. Sheryl WuDunn, Nick Kristof, we thank you both.

SHERYL WUDUNN: Thanks very much.

NICHOLAS KRISTOF: Thanks so much, Judy.

"Half the Sky" airs on most PBS stations tonight and tomorrow night. You can watch more excerpts about Sierra Leone, about India's caste system and education in Afghanistan on our website.

Meet Agnes: Orphan, Student, Survivor of Sexual Violence in Sierra Leone

Mon, 01 Oct 2012 16:17:00 EDT

Watch One Girl's Long Road to School and Safety in Sierra Leone on PBS. See more from Independent Lens.

Agnes, a 17-year-old orphan in Sierra Leone, was told by a teacher that he would enroll her in school if she would have sex with him.

"Really it's like forced marriage. He's basically enticed her into sexual slavery," said Amie Kandeh of the International Rescue Committee, which is trying to help the girls in Sierra Leone through Rainbo Centers that offer medical care, counseling and police referrals when they wish to press charges.

The teacher never enrolled Agnes in school, so she enrolled herself, but the abuse continued. She ended up leaving school for four years, but recently decided she wanted to return.

"Agnes is going to be in class with girls who are between the ages of 9 to 12," said Kandeh, but instead of dwelling on that, she advised Agnes to focus on her dream of becoming a doctor.

Agnes and other stories of violence and survival are featured in a four-hour documentary on PBS. "Half the Sky: Turning Oppression into Opportunity for Women Worldwide" premiers in two parts on Monday and Tuesday at 9 p.m. ET.

"If you educate girls and bring them into the formal labor force, they can astound you," said Sheryl WuDunn, who co-authored "Half the Sky" with her husband, New York Times columnist Nicholas Kristof.

In some areas of the developing world, however, women are "rarely given a chance to go to school and work," said WuDunn. The mentality is often "'why waste money on a girl, because she will amount to nothing.' ... But we know that's not the case."

In places like Sierra Leone, where there is conflict, "there tends to be a lot of gender-based violence including rape," said Kristof. "When the conflict ends, soldiers stop killing each other but the rape continues."

Sierra Leone, in western Africa, is slowly returning from an 11-year civil war that ended in 2002.

And in places where women and girls are at the bottom of the hierarchy, few resources are available to them.

But according to Kristof, in many cities in the world, there are local groups working to help women and girls, and the documentary highlights some of them. In addition to Sierra Leone, he visits Cambodia, Kenya, India, Somaliland, Vietnam, Afghanistan, Pakistan, Liberia and the United States.

Kristof brought several celebrity activists with him to see the atrocities: actresses America Ferrera, Diane Lane, Eva Mendes, Meg Ryan, Gabrielle Union and Olivia Wilde.

"Sheryl and I had some reservations about bringing these celebrities along. We didn't want to have these celebrities caught shoplifting or running around adopting babies," he laughed. But "not only were they great to work with," he said, but they served as a proxy to the viewer who also might be encountering these issues for the first time.

For example, in Somaliland, they wondered how to cover female genital mutilation for television, said Kristof. So they ended up filming actress Diane Lane watching a video of a girl getting cut, he said, and the expression on her face was incredibly powerful.

The next step in the Half the Sky Movement is a Facebook game launching Nov. 13.

Video Excerpt: India's Caste System...

Watch The Impact of India's Caste System on Women on PBS. See more from Independent Lens.

What an Education Means in Afghanistan...

Watch Sakena Yacoobi on Educating Women and Girls in Afghanistan on PBS. See more from Independent Lens.

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A Future Without AIDS? Global Health Leaders Point to Education, Prevention

Thu, 27 Sep 2012 16:42:00 EDT

Watch a replay of Ray Suarez at Columbia University moderating a panel of global health leaders as they discuss the future of combating AIDS.

If you're old enough, you can remember when you first heard about a disease, or a group of diseases found among young men in New York and San Francisco. In those early years, understanding the biology of what became known as the human immunodeficiency virus, or HIV, and trying to stop its rapid spread became a worldwide crusade. The house was on fire, the danger real and the future uncertain.

Things now have changed enough to hold a conference with the audacious title, "A Future Without AIDS: Dream of Reality?" For this reporter, being invited to moderate a conversation of superstars in the global battle against AIDS was a chance to pick the brains of some of the most influential, and also the most experienced professionals in the struggle:

-- Dr. Anthony Fauci of the National Institute of Allergy and Infectious Disease -- Dr. Eric Goosby, US Global AIDS Coordinator at the State Department -- Michel Sidibe, Executive Director of UNAIDS, the Joint UN Program on HIV/AIDS -- and Dr. Wafaa El-Sadr, Director of ICAP at the Columbia Mailman School of Public Health.

I have covered AIDS as a reporter since the earliest days of the detection and diagnosis of the disease. At a hospice for infected infants I masked up and held dying infants in my arms. I've interviewed thin men with sunken eyes and lesions from Kaposi's Sarcoma -- one of the opportunistic diseases plaguing sufferers in advanced stages of AIDS -- who talked of dying in their twenties. I've sat with exhausted clinic operators coming off yet another 15- or 16-hour day as they struggled to get their arms around a wildfire of disease. In short, I've been interviewing people who thought we would never reach the point where we could have a realistic conversation about the end of the AIDS epidemic.

The reports from the field are good: Sidibe talked of declining levels of new infections in the developing world and the suppression of the virus in the bloodstreams of millions of people who are getting anti-retroviral (ARV) treatment. Dr. El-Sadr said early research would indicate that people living in hard-hit communities do not return to risky personal behavior as their friends and neighbors stop dying of the disease. Dr. Goosby said that even while funds are being cut for the President's Emergency Program for AIDS Research (PEPFAR), squeezing inefficiencies out of the delivery of care in poor countries has meant delivering care to even more people for less money. Dr. Fauci, one of the world's most important veterans in the fight against AIDS, spoke of steady progress toward a vaccine, even though HIV has proven to be a daunting foe when compared with other viruses.

Public health executives and clinicians tend to be cautious men and women, unwilling to create false excitement or unwarranted optimism. They choose their words carefully. Sitting on that stage at Columbia University, some of that careful reserve fell away. So much progress has been made on so many fronts that they felt empowered to speculate about reaching that point where you can see the back of an epidemic being broken.

The reason for the excitement is summed up in three words: treatment as prevention. The current arsenal of ARVs has had such success in suppressing the disease in infected people that the risk of mother to child transmission in the womb is steadily dropping. As more people know their status, the chance of uninfected people having an encounter with a person who will infect them accidentally is also plunging, and those suppressed viral loads among patients who are on treatment infecting someone new is dropping even if the people on treatment engage in risky behavior.

In short, once a person is on treatment the danger of AIDS to their lives drops precipitously. If they are responsible sex partners their chances of infecting another is very small, and the chances of a new infection is lower and lower even when they don't take precautions.

So this panel -- representing the Big Powers in the war on AIDS, research universities, the U.S. government, and the U.N. -- all having been on the front lines during the worse days of the epidemic's spread, all say the world is inching closer to durable victories, and many more lives saved.

One caution came from Dr. Fauci, who reminded the audience at Columbia and via the live web stream that once that hoped-for day of widespread control of HIV arrives, the world would make a colossal mistake if it sat back, declared victory and relaxed. He reminded the audience of other defeated diseases, like polio, that come bouncing back when prevention is relaxed in the face of declining perception of threat.

Looking specifically at the U.S., Dr. Goosby and others talked of the ways the diseases profile differs from that of other places in the world: it is more concentrated among men who have sex with men, and more concentrated among specific minority groups like black men and black and Latino teens. He also talked about the lowered expectation of effective testing, detection and follow-up in rural communities in the South because of stigma, lack of access to care, and perceived gaps in privacy guarantees.

All in all, these important figures in the world effort to contain HIV spoke of their optimism for the coming years, Sidibe going as far as to insist that zero mother-to-child transmission as soon as 2015 was possible given the medical systems, education and prevention strategies already in place today. He has evangelized around the world for the goal of "zero-zero-zero": zero new infections, zero discrimination against those already infected, and zero deaths from AIDS. He chuckled when he talked of being called naïve when he first expressed that hope, and said in the intervening years the world has come much closer to achieving all three.

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Global Health Leaders Have Vision for World Without AIDS

Wed, 26 Sep 2012 18:46:00 EDT

Watch Ray Suarez moderate a panel of global health leaders as they discuss the future of combating AIDS. A live stream will be available here from noon to 1:30 p.m. ET Thursday.

Thursday in New York, the ICAP at the Columbia Mailman School of Public Health, (http://www.columbia-icap.org/), hosts a conference featuring some of the most prominent leaders in the world's struggle against AIDS.

The theme is a provocative one: A Future Without AIDS, Dream or Reality? Strides in HIV suppression and breakthroughs in research have brought the world to the edge of what may be -- may be -- the beginning of the end of the disease as a worldwide scourge.

The anti-retroviral drugs that have become lifesavers around the world do more than just save one life at a time. ARVs suppress the HIV virus in the fluids of infected people. Mothers on ARVs are significantly less likely to give birth to HIV-infected children. Infected adults taking the drugs are significantly less likely to pass on the drug, even if they don't take precautions in their sexual encounters. In short, ARVs save lives, lengthens lives and stops transmission.

ARVs are still beyond the reach of millions of infected people around the world. At the same time, American taxpayers are keeping millions of HIV positive people alive, keeping the infection from transitioning to full-blown cases of AIDS. Healthy people raise healthy children, work in farms and factories, and help their countries grow instead of holding them back.

It's promising. After the tremendous struggles around the world to fight HIV, it's tantalizing to imagine the next steps toward a world without AIDS. Dr. Wafaa El-Sadr of Columbia University and the founder of ICAP, has brought Dr. Michel Sidibe of UNAIDS; Dr. Eric Goosby, President Obama's global AIDS coordinator; and Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health for a look at the way ahead. I will moderate the conference, and we'll stream it live from Columbia University in New York, here at the Online NewsHour from noon to 1:30 p.m. ET Thursday.

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Where 'Smoke-Free' Isn't the Norm: Global Tobacco Use Booms in Developing World

Mon, 20 Aug 2012 18:21:00 EDT

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JEFFREY BROWN: Even as smoking declines in the U.S. and other countries, a new study published in the British medical journal "The Lancet" reveals that the use of tobacco in developing countries is booming.

The report titled "The Global Adult Tobacco Survey" looked at tobacco users in 14 developing nations and included data from the U.S. and the U.K. for comparison. It found that about half the men across the low- and middle-income nations use tobacco, mostly smoke products. The number was much smaller for women, 11 percent. But the survey found that women are starting at younger ages than in the past.

Russia had the highest rates -- 60 percent of men and 22 percent of women used tobacco in some form. And China had the largest number of users, some 300 million.

In the meantime, health advocates in Australia, which wasn't included in the new study, scored a victory last week in their fight against tobacco use. The nation's high court upheld a new law requiring that cigarette boxes feature vivid images and warnings on them without company logos.

The World Health Organization says that if current trends continue, the global death toll from tobacco will reach eight million a year by 2030.

And we're joined now by Gary Giovino, the lead epidemiologist on the new study. He's the chair of the Department of Community Health and Health Behavior at the University at Buffalo in New York.

Welcome to you.

Let me just ask you first, what was the most important thing that came from this study for you?

GARY GIOVINO, State University of New York at Buffalo: Well, the magnitude of tobacco use in the different countries, the fact that we saw some different patterns, that smoking, for example, is very high among men and women in Russia, especially young men and women. In Russia, Turkey and Ukraine, it was very high.

Another very important finding was the dominance of the manufactured cigarette.

A lot of people think cigarettes are just tobacco chopped up and wrapped in paper. But the manufactured cigarette is a technologically sophisticated device designed to mask harshness and inject flavors and increase nicotine.

So, and these are made by multinational tobacco corporations or government corporations that promote their use and work to undermine efforts to reduce their use.

JEFFREY BROWN: One thing that jumped out at me was the low number of people who quit smoking once they have started, especially as compared to in the U.S., for example. What does that tell you? Why is that happening?

GARY GIOVINO: Well, I think we have some cultures, particularly, for example, in China and India, where quitting isn't emphasized.

Only 10 percent of people in China and India who have ever smoked daily have quit. That compares to about 45 percent when we look at age-standardized data in the United States and the United Kingdom, where tobacco control efforts, where efforts to educate people about tobacco use and encourage quitting and prevent initiation, have been going on for a long time.

And it's also much lower, for example, than 35 percent around in Brazil and Uruguay, where they have been doing tobacco control for a while. So, I hope that China and India, the governments will look at that and try to improve their efforts to promote quitting among people who have become addicted and daily smokers.

JEFFREY BROWN: Well, why do you think the rise is happening and these kinds of disparities is happening when you -- particularly as the numbers go down in the U.S. and other countries?

GARY GIOVINO: Well, many of the same things that we saw happening in America, with tobacco being glamorized, with tobacco being made -- with marketing being directed towards women that make it look glamorous, that make it look like a -- something that's associated with gender equality and freedom.

Those kinds of things are happening. And we're seeing the age of initiation going down in many of our low- and middle-income countries.

And, of course, we have social norms that support tobacco. In many of these countries, for example, they haven't given smoke-free the privilege, the right. They haven't given smoke-free the default option, where many people are still bathed in tobacco smoke.

So, smoking is the norm, instead of non-smoking being the norm, in many countries where quitting hasn't become normative.

In Brazil and Uruguay, tobacco control has been going strongly, and they have very strong smoke-free provisions.

JEFFREY BROWN: We mentioned in our set-up what's going on in Australia, what they're preparing to do with the labels. Is something like that possible or do-able in some of these countries? What do we know that does work?

GARY GIOVINO: Well, plain packaging is theoretically possible in any country.

That will be challenged in court, but the Australian highest court upheld the legal challenge. And it really doesn't cost governments much money to -- I mean, except to defend the lawsuits -- to mandate plain packaging and to mandate very strong warning labels.

Very strong warning labels inform smokers better than weaker warning labels, so graphic warning labels that give a strong message about the health effects of tobacco.

The other things that work are protecting non-smokers, of course, offering people help with quitting, hard-hitting mass media campaigns, and enforcing advertising bans or restrictions.

In many countries, they can actually ban advertising. And they do. In our country, we can only restrict it. And then also raising taxes -- when the price goes up, consumption goes down. But then, in many countries, they use some of the money that they get from raising taxes to fund media campaigns, for example, and other tobacco-control strategies.

JEFFREY BROWN: Gary Giovino, thanks so much for joining us.

GARY GIOVINO: My pleasure. Thank you.