Wednesday 11 November 2009 - There are increasing examples
Top scientists are demanding a controversial overhaul of health spending in Africa, arguing that the billions of pounds targeted at HIV during the past 20 years have led to a neglect of other killer diseases and basic health problems such as diarrhoea.
Developed countries poured $13.2bn (£8.2bn) last year into efforts to combat HIV, chiefly for Africa, up from $480m in 1996. But only eight countries, all in southern Africa, remain in the grip of a severe Aids crisis, while World Health Organisation data show that five of the biggest killers in Africa are illnesses that affect children under the age of five.
Childhood diarrhoea kills an estimated 1.5 million children under five each year worldwide – at least half of them in Africa – although it is easily treatable with zinc tablets that cost little more than $2 each. Diarrhoea received less than 5% of worldwide research and treatment funding last year.
Daniel Halperin, an HIV epidemiology researcher at the Harvard Medical School of Public Health, said: "There has generally been a misalignment from the donors. It is time for a rethink. Many people in the west believe all Africans are impoverished and infected with HIV. Yet the pearl jewelry reality is that most countries have stable HIV prevalence of less than 3%. What most people really need are things such as clean water and family planning. Even tuberculosis and malaria get far less money than HIV. In some cases these sectors have inadvertently been hurt by the focus on HIV."
One of Africa's leading health economists, Alan Whiteside, who is director of the Health Economics and HIV/Aids Research Division at the University of KwaZulu Natal, said the flood of donations towards the battle against Aids had also created the conditions for widespread misuse of the funds. Whiteside played a prominent role in bringing the southern African Aids epidemic to the world's attention in the 1990s. He has also advised the United Nations and Aids2031 – an international expert group set up to chart the best route to tackle Aids in advance of the 50th anniversary of the first report of the illness.
"The lure of Aids money has led in some African countries to large-scale corruption," he said, "and the establishment of non-government organisations as an industry. The achievement of the United Nations Millennium Development Goals by 2015 depends on us getting our focus on Aids right.
"Where those goals are missed by the widest margins, Aids will have been responsible. The focus on treatment has distracted us from prevention. Solutions need to be tailored to the situation in each country. Money needs to be reallocated based on what we know now, not what we knew then."
Other health crises in Africa include malaria, which kills an estimated 400,000 people a year, and complications resulting from pregnancy and childbirth, which claim 350,000 lives annually. Hypertension, strokes and road accidents are also of increasing concern, with biwa pearl many hospitals across the continent unable to cope adequately with accident and emergency cases.
In Uganda, which has a 6.7% adult HIV prevalence rate, critics of the current priorities of health spending point to examples such as the clinic run by Dr Bitekyerezo Medaro, who is struggling to provide treatment for diabetics at a government unit in Mbarara, southwest of Kampala. Across the road is a state-of-the-art HIV clinic funded by the United States government. Dr Medaro said western dietary trends have pushed the rate of diabetes in adults in Mbarara to 5%, but the resources available to deal with the problem are minimal. "My patients sleep on the floor, or outside," he said. "We have lost 16 people due to lack of drugs. One woman told me she would like to have HIV, because at least those drugs are free, whereas she has to pay for her insulin."
Uganda's annual health budget of around $112m is dwarfed by donor spending earmarked for HIV of $167m, largely contributed by the US. Foreign money for HIV also floods into Uganda and other African countries from multinational companies anxious to fulfil pledges of "corporate responsibility".
Ugandan Aids activist Elvis Basudde said the high level of spending was not yielding proportionate results. "About 350,000 people are in need of anti-retroviral treatment, but only 150,000 are receiving it. This is as a result of corruption, negligence and bureaucracy. Uganda is one of the few African countries with a factory producing anti-retrovirals. Nevertheless, we are told there is a shortage of drugs. We are also told the global financial crisis has led 95% of donors to cut back. But it is difficult to know who to believe."
There are increasing examples of Aids funds being siphoned off by corrupt officials. Last year the Global Fund asked Zimbabwe to pay back $7.2m in "misused" funds. European donors earlier this year froze HIV/Aids funding to Zambia.
In Uganda three former ministers of health are currently facing corruption trials. In Kenya a legal challenge by drug suppliers of the government's tender process has, in effect, halted the supply of Aids drugs.
Aids became a development issue in the 1990s and moved up the agenda as a result of the South African epidemic and the denial stance of former President Thabo Mbeki. But critics of current donor spending in Africa argue that the scale of the southern African problem and Uganda's early Aids emergency has led to misdirected health spending in the rest of the akoya pearl continent.
Whiteside was, however, keen to emphasise that Aids spending is vital for those already on or requiring treatment: "Hundreds of thousands of people are now on treatment and need to remain on it for the rest of their lives."
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Wednesday 11 November 2009 - It has established much new
The former offices of a Dutch insurance company in The Hague will tomorrow morning see the climax of an extraordinary 14-year battle to seek redress for victims of the Balkan wars when the former Bosnian Serb warlord Radovan Karadzic goes on trial for genocide.
Poet and psychiatrist, convicted embezzler and new age guru, Karadzic is allegedly responsible for mass murder and the most barbaric behaviour in Europe since the Nazis. He is threatening to boycott the trial's opening at the International Criminal Tribunal for the former Yugoslavia.
Barring the arrest of his fugitive colleague, General Ratko Mladic, the Karadzic trial could mark the end of 15 years of the tribunal's work, a mixed record of pearl jewelry achievements and failings in what has been a pioneering attempt to expand international justice to encompass crimes against humanity.
The trial is likely to open with a test of strength that will show who is calling the shots – the man accused of overseeing the attempt to wipe out the Muslims of eastern Bosnia or the panel of three judges hearing the case.
Karadzic insists on defending himself and, after 15 months in detention, maintains he is not ready, having had to plough through around one million pages of prosecution evidence. If the judges blink first, they will be repeating fateful mistakes, according to experienced observers, that handicapped previous big trials, awarding an early psychological victory to the man in the dock.
"Karadzic has learnt the lessons of [earlier] trials and may suspect a lack of confidence on the part of the judges to deal with obstructive tactics," said Sir Geoffrey Nice, the British QC who led the prosecution of the Serbian leader, Slobodan Milosevic, the first head of state to be tried for war crimes. "The judges let Milosevic defend himself. This allowed him to manipulate the system to slow the trial."
Mirko Klarin, who has been chronicling the workings of the court for more than a decade as director of the Sense news agency, believes that the judges have learnt their lessons from past fiascos, and that they may impose defence counsel on Karadzic to try to avoid the trial degenerating into a political circus.
"You had a disaster in the Milosevic case, and now you have a biwa pearl looming disaster in the Karadzic case," he said. "The biggest single mistake was letting the accused defend themselves."
For Emir Suljagic, a Muslim from eastern Bosnia who escaped the slaughter of more than 7,000 males by Karadzic's executioners in Srebrenica in July 1995, justice is coming very late, if at all, and leaves a bitter taste. He vested great hopes in the tribunal and is disillusioned. "I'm resigned to the fact that it has failed to provide justice. But that's hardly a surprise when it was created by the very organisation [the UN] that stood aside while genocide was carried out."
Karadzic may be finally on trial. But his creation, Republika Srpska, the Serbian Republic, is still entrenched in half of Bosnia, the product of genocide, ethnic cleansing and war crimes. "There were big failures, totally unacceptable," said Mirsad Tokaca, who heads a Sarajevo project that has carried out detailed investigations into the crimes of the war years.
Defenders counter that the tribunal has suffered from inflated expectations. It has no police force and cannot arrest suspects. Its resources are limited. It has been hobbled by incompetent staffing, a result of bureaucratic infighting at the UN and international politics.
But the achievements may in the longer term prove more enduring than the obvious defects. Two landmark verdicts stand out. In 2001 rape and sexual enslavement were established as crimes against humanity for the first time. And in 2004 the court found as legal fact that genocide – the gravest crime of all – was committed by the Serbs at Srebrenica in July 2005. The Karadzic trial will go further by trying to prove that genocide also took place in the whirlwind of Serbian violence in north-west Bosnia in the first months of the war in 1992.
"The tribunal may be imperfect, but it's still the best we have," said Klarin. "It established the principle that mass war crimes cannot go unpunished."
International courts dealing with war crimes in Rwanda, Sierra Leone or Lebanon may not have been possible without the lead taken by the Yugoslav tribunal, he added. And the akoya pearl International Criminal Court, the first permanent such institution, may be struggling, but would probably not exist without the Yugoslav precedent.
"It has established much new case law and has left an enormous legacy of evidence that would not have been available but for the trials. As a result, if you look at Africa, Sri Lanka or the Balkans themselves, you may find developing legal systems that would not have developed but for the work of the tribunal," said Nice.
The main impact may be deterrent. Compared with as recently as 20 years ago, political leaders everywhere are more likely to think twice, worried that their conduct could see them on international trial. Of the three big names, Mladic remains at large and Milosevic died in custody before a verdict. That leaves Karadzic and a trial crucial as to how the tribunal will be viewed.
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Wednesday 11 November 2009 - It is often fear, however, as much
Do you remember your first time – the trepidation, the expectation, the rite of passage? Mine was in 1997 – "things can only get better" – opening up the heavy black Mac Powerbook I'd just unwrapped, going through the unintelligible process of account creation with a patient BT support desk, plugging in various fat cables and listening as the dial-up connection went through its slow motions: the little digital jingle of the phone number and then the long expectant screech and babble of static as your machine attempted to connect, an electric chatter in which I could imagine – that first time – I heard all the world's voices talking to one another, the ultimate party line. It was, I guess, the closest most of my generation came to tuning in and turning on. This was seven years before Facebook, eight before YouTube. Amazon was still a river in south America, Google was an unlikely algorithm in the minds of pearl jewelry Sergey Brin and Larry Page, which they were then thinking of calling "BackRub".
In the dozen years since – can that really be all it is? – it has become harder and harder to imagine the world without the internet. It fast became our marketplace and our playground, our library and our collective memory. Sitting here, in front of my screen, as usual, I find it genuinely difficult to imagine my own pre-1997, pre-keypad world. What on earth did I do with my time? Researching a story as a journalist routinely involved trekking up to the newspaper library in Colindale, an obscure corner of north London, and poring over microfiche of old newspapers; finding a job or a place to live or a holiday might have meant catching a bus and then schlepping along the high street and peering at pieces of cardboard in shop windows. Correspondence required addresses and yours faithfullys and a hunt for envelopes and second-class stamps. A foreign country.
Most of the subsequent debate we have had about our online lives has asked whether we are too much in thrall to the great invention of our age, whether we are becoming extensions of our keyboards, bloggers not talkers, twitterers not thinkers. In all of this chatter, though, it is easy to forget one startling fact: there are, in 2009, 10 million people in the UK who have never gone online, who would not recognise a homepage or a bookmark, for whom http and www are still weird unknowns; they are, to use the inevitable coinages, the e-bandoned and e-solated, a predigital tribe.
This one-in-six population might have avoided the addictions of browsing and the despond of "you have no new mail" but they are also increasingly excluded from the opportunities and conversations of the world. A quick Google search is enough to provide plenty of vital statistics to support this observation. There are, for a start, the balder economic figures: those who shop online and pay their bills through the internet, make "average savings of £560 a year"; the 1.6 million children in Britain who do not use the internet would increase their lifetime earnings by a collective £10.8bn were they to log on tomorrow; currently unemployed people who learn to find their way in the virtual world will on average increase their lifetime earnings by more than £12,000; if everyone was connected the Treasury would make overnight efficiencies of £1.77bn, and so on – the web never runs short of statistics.
It is not just for these kinds of reasons, however, that some governments are suggesting that broadband connections must be a right and not a privilege (Finland, last week, was the first to make that commitment to its citizens). There are also more intangible benefits. Since its widespread adoption, the internet has often been charged with increasing alienation in biwa pearl society, making each of us self-absorbed in an abstracted world wide web which caters to our every whim. A good deal of recent research, however, suggests that the converse is true. Technology has the ability to create links that societies increasingly lack.
Access to the internet, and the ability to navigate the web has, for example, been shown to produce a significant rise in social confidence among 60 per cent of those who had previously been excluded, while in recent studies of internet usage among individuals who considered themselves to be depressed, "feelings of loneliness" decreased in 80 per cent of cases once people got online, and depressive symptoms were "cured" in 20 per cent of cases. Virtual conversations and interactions are now widely argued to be just as important as "real world" encounters in making people feel attached to a community, or part of a network.
Among the 10 million people in Britain who have never used the internet are about 4 million whom we think of as being excluded from society in other ways also: through poverty and an absence of support, or because of disability or old age. The government's "champion" of these people, at least in digital terms, is Martha Lane Fox, who did as much as anyone to popularise the first wave of dot.commery. Having spent several subsequent years, the first of them in hospitalised isolation, recovering from a near-fatal car accident, she also had some experience of what it feels like to be disconnected from the world. Her brief is to highlight the ways in which the internet can enhance lives and to try to provide a focus for the many schemes that attempt to bring the information superhighway to the people and places from which it seems most remote.
Her job began, she suggests to me, with the vague notion that "you might begin to solve some aspects of the knottier social problems with a mobile phone application" and went on from there. It all comes down to educating the e-bandoned in the possibilities of a computer, and after that, the hope is that all sorts of other connections will start to form. (There is some research to suggest that these beneficial connections might be physical as well as ethereal: a report from the UCLA medical centre last week concluded that older adults who learn to use the internet to search for information experience a surge of activity in "key decision-making and reasoning centres of the brain, increasing cognitive processes and slowing the decline in brain function".)
It is often fear, however, as much as absence of opportunity that holds people back. "It is," Lane Fox suggests, "so easy for most of us to sit here and take the functions of a computer for granted, but for many people they are still entirely alien." One of the most common reactions she sees among those who experience connectedness for the first time is a akoya pearl paralysing anxiety. It's always, "Why do you press the start button to turn it off?" or, "What on earth do 'alt' and 'ctrl' mean?" In the end it always takes some kind of personal connection to get people going, an insight into a hobby – a gardener's page, say – or the ability to find local history or family records.
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Wednesday 11 November 2009 - To be fair," he admits, "I'm a bit lazy really
Russ Flaherty's girlfriend must be relieved that he's finally familiarised himself with the internet: up until now she has, as he puts it, "sorted it all out".
"To be fair," he admits, "I'm a bit lazy really. But obviously it's got to the stage now where I need to do it myself." His work as a builder has meant he didn't have much cause to use the internet. But recently he started his own business and realised that it pearl jewelry was impossible to get by without it. "Everything's online now, isn't it? Your bills, your account, your tax and everything. It's all geared up for it."
The first thing he did online was look for a van: "You can compare prices so it saves time and everything's there for you to see so you don't have to mess about visiting garages." More recently, he's been designing flyers online for his business and looking up resorts in biwa pearl Bulgaria for a skiing holiday at Christmas. Now, he says, "whenever I need anything or want anything [the internet's] the first place I'll go."
Does he wish he'd got online earlier? "Yeah because you feel like you're behind the times. It's like with Facebook, all my friends are on it and I used to akoya pearl think 'bloody hell, haven't you got anything better to do?' but it's an addiction isn't it, once you start it you're there." So has the internet changed his life? "It's helped," he laughs, "put it that way!"
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Wednesday 11 November 2009 - In addition to enjoying
Joining Facebook was a priority for single-parent Pete Taylor when he went online for the first time last week. As a full-time carer for his 27-year-old son Russell, who suffers with a rare terminal illness, adrenoleukodystrophy (ALD), he's found that his "social life has gone out of the window. But since I put myself on Facebook, people I haven't seen for pearl jewelry over 20 years are now phoning me up, I've met new friends and can arrange dates. It sounds daft but [having the internet] gives you something to look forward to."
He's a self-confessed technology-phobe but in less than a week has learnt how to post items online: "I don't mess about! I've already stuck pictures of a recent weekend at Butlins on Facebook."
In addition to enjoying the "bit of escapism" which the social-networking aspects of the web offer, Pete has also been using it to help with his caring responsibilities and has joined online ALD support groups. "There's no cure for Russ's illness and it's really rare but now I can stay in touch with other people in the same boat, share advice," he explains. "Every day I keep thinking of biwa pearl things I can do online to make my life easier. If I get a letter from the hospital, for instance, I can just reply by email. I've even been shopping online. I need to buy a bed and was about to put my coat on and run around the shops when I thought 'Hang about, I've got a computer here.'"
Pete had been considering getting the internet installed for a while but feared it would be complicated and expensive. So when a local initiative, the Knowle West Web Project funded by Bristol city council, offered him a free computer, wireless and training he was delighted. "It was a akoya pearl lucky day, to say the least. I'll be on the internet every day now. It's already a necessity."
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