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	<title>Jina Moore</title>
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		<title>Why this rocks: J. Lester Feder on same-sex marriage in South Africa</title>
		<link>http://www.jinamoore.com/2013/06/18/rocks-lester-feder-samesex-marriage-south-africa/</link>
		<comments>http://www.jinamoore.com/2013/06/18/rocks-lester-feder-samesex-marriage-south-africa/#comments</comments>
		<pubDate>Tue, 18 Jun 2013 07:54:52 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[Foreign Writing that Rocks]]></category>

		<guid isPermaLink="false">http://www.jinamoore.com/?p=5300</guid>
		<description><![CDATA[First and foremost, it's about South Africa. There's no universalizing paragraph linking the issue in South Africa to the rest of the continent; where there is that link, it's subtle and sensical, connecting the South African story to other stories because they are actually connected, not because the piece, to exist, has to say something [...]]]></description>
				<content:encoded><![CDATA[<p class="first-child ">First and foremost, it's about <i>South</i> Africa. There's no universalizing paragraph linking the issue in South Africa to the rest of the continent; where there is that link, it's subtle and sensical, connecting the South African story to other stories because they are actually connected, not because the piece, to exist, has to say something about "Africa."  That means what's missing is as fulfilling as what's there: There's no recitation of the now-familiar legal assault on gay rights in Uganda, or the turnaround in Malawi, or the general prejudice in so many places about which it would be so easy to generalize -- and with which it would be so easy for the story to prop up its own importance. Instead, it's about this irony: South Africa legalized same-sex marriage in 2006. It grants asylum to people on the basis of sexual orientation. But it's still hard as hell to be gay in South Africa.</p>
<p>Feder does -- or gets to do -- what many writers elsewhere don't: He concentrates on local detail. This is primarily the story of individuals and the difficulties they encounter living their everyday lives, and it's not worried about talking too much about court rulings, political developments or tricky history. In spite of this unabashedness, the thing most readers (and editors, I'm guessing) would probably expect doesn't happen: It doesn't get boring.</p>
<p>It's also bolstered by research, but that research comes from South African think tanks, not, say, Human Rights Watch. Feder dives right into the real mess of the real world -- how people live and what constrains them. He trusts that those details are enough to keep us interested, "even though" it's a story about South Africa.</p>
<p>Guess what? He's right. The people he encounters open up to him, and he opens their lives to us, acts of generosity on the part of both writer and subjects. The context of homophobia is more complicated in a story that dives so deep.  Guess what? It's not just because "Africans" have "ancient traditions" that oppose same sex relationships.  "Conservative Afrikaners, whose politicians criminalized same-sex relationships along with interracial ones, have left a legacy of ongoing homophobia for those families who once benefited from apartheid’s privileges," Feder writes. There's even a lot here on the Dutch Reform Church and its opposition to same-sex marriage -- which, guess what, is not a product of exported American evangelism, which has taken up so much of the narrative space on this issue in earlier work.</p>
<p>That earlier work is important, and covering same sex marriage and LGBTI rights across the continent is an important journalistic priority.  But this story so delightfully deviates from the pack, and in doing so proves that the local context so  writers, editors and readers are afraid of is an advantage, not a liability.  Kudos.</p>
<p><a href="http://www.buzzfeed.com/lesterfeder/same-sex-marriage-is-south-africas-law-but-stories-differ" target="_blank">Go read the piece</a>.</p>
<p>&nbsp;</p>
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		<title>Sunday in a South African township</title>
		<link>http://www.jinamoore.com/2013/05/29/sunday-south-african-township-2/</link>
		<comments>http://www.jinamoore.com/2013/05/29/sunday-south-african-township-2/#comments</comments>
		<pubDate>Wed, 29 May 2013 19:51:55 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[Uncategorized]]></category>

		<guid isPermaLink="false">http://www.jinamoore.com/?p=5279</guid>
		<description><![CDATA[Oops! Having a technical glitch with my slideshow. Hope to fix it soon! I came to Tshepisong to meet Olga. When she had only two children herself, and she was only 30 years old, Olga began her life as a foster mother to AIDS orphans -- four children of her sister's, and later two children [...]]]></description>
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        			<content:encoded><![CDATA[<p class="first-child "><em>Oops! Having a technical glitch with my slideshow. Hope to fix it soon!</em></p>
<p>I came to Tshepisong to meet Olga. When she had only two children herself, and she was only 30 years old, Olga began her life as a foster mother to AIDS orphans -- four children of her sister's, and later two children of her aunt's. <a href="www.csmonitor.com/Specials/Africa-AIDS-Orphans" target="_blank">The Christian Science Monitor has been writing about Olga and her journey since 2007</a>.</p>
<p>As Sunday wound down, this is what I saw walking around Tshepisong, a township not far from Johannesburg. I was, above all, impressed. For instance: If I had a tin shack and a broken down wooden gate and an outhouse, would I spend the time and money and effort needed to coordinate them all in a delightful shade of pink?  I'm pretty sure I'd probably just watch TV.<br />
</p>
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		<title>Sunday in Olga&#8217;s Shack</title>
		<link>http://www.jinamoore.com/2013/05/29/sunday-south-african-township/</link>
		<comments>http://www.jinamoore.com/2013/05/29/sunday-south-african-township/#comments</comments>
		<pubDate>Wed, 29 May 2013 19:15:07 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[Vignettes]]></category>

		<guid isPermaLink="false">http://www.jinamoore.com/?p=5275</guid>
		<description><![CDATA[At least, it's what my Sunday looked like, when I visited Olga and her family in Tshepisong, not far from Johannesburg. If you look closely, you'll see this is a tin shack. But you have to look closely, because nine-year-old Bokamoso and his three-year-old brother, Neo, are having so much fun with each other, they'll [...]]]></description>
				<content:encoded><![CDATA[<p class="first-child ">At least, it's what my Sunday looked like, when I visited Olga and her family in Tshepisong, not far from Johannesburg. If you look closely, you'll see this is a tin shack. But you have to look closely, because nine-year-old Bokamoso and his three-year-old brother, Neo, are having so much fun with each other, they'll distract you.</p>
<p><a href="http://www.jinamoore.com/wp-content/uploads/2013/05/output_LXcmDZ.gif"><img class="alignleft size-full wp-image-5276" alt="output_LXcmDZ" src="http://www.jinamoore.com/wp-content/uploads/2013/05/output_LXcmDZ.gif" width="300" height="300" /></a></p>
<p>PS: That blurry white hand in there belongs to an amazingly good-hearted woman who drove us to visit Olga, who is a friend of hers, and whom Neo cackles at every time she tries to tickle him.</p>
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		<title>Boss me around in Africa!</title>
		<link>http://www.jinamoore.com/2013/05/21/boss-africa/</link>
		<comments>http://www.jinamoore.com/2013/05/21/boss-africa/#comments</comments>
		<pubDate>Tue, 21 May 2013 10:51:05 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[African Great Lakes]]></category>
		<category><![CDATA[Rwanda]]></category>

		<guid isPermaLink="false">http://www.jinamoore.com/?p=2747</guid>
		<description><![CDATA[I’ve just landed back in Rwanda, which loyal readers who’ve forgiven years of mostly silence on this blog will recall as my favorite place on Earth, and I’m gearing up for some really exciting work with the International Reporting Project, as one of their six New Media Fellows this year. By the way, this crop [...]]]></description>
				<content:encoded><![CDATA[<p class="first-child "><a href="http://www.jinamoore.com/wp-content/uploads/2013/04/keats-rw.jpg"><img class="alignleft size-medium wp-image-2748" alt="Rwanda from DK" src="http://www.jinamoore.com/wp-content/uploads/2013/04/keats-rw-300x199.jpg" width="300" height="199" /></a></p>
<p>I’ve just landed back in Rwanda, which loyal readers who’ve forgiven years of mostly silence on this blog will recall as my favorite place on Earth, and I’m gearing up for some really exciting work with the International Reporting Project, as one of their six New Media Fellows this year.</p>
<p>By the way, this <a href="http://internationalreportingproject.org/stories/view/announcing-the-2013-irp-new-media-fellows">crop of New Media Fellows</a>, IRP’s first, is something special (if I’m allowed to say so).  After stiff competition for only six spots, guess what happened? We’re all women. We’re diverse – I’m the only white face in the crowd – and we’re all over the world.  Also, we’re engaging with media not just as traditional journalists, but as bloggers, novelists, poets, publishers and more. So if you aren’t already following IRP’s New Media Fellows, you should. You can catch us all on Twitter via <a href="https://twitter.com/IRPChirps/new-media-fellows-2013">this handy list</a>, or you can follow our blogging, aggregated at IRP's <a href="http://internationalreportingproject.org/blog">blog site</a>.</p>
<p>I’ve been preoccupied with getting things in order, so my reporting begins in earnest soon, but I can’t resist sharing some tidbits. I’m amazed, still, how quickly things can change. The former US Embassy is now apartment buildings.  The Marriott hotel is taking shape, one shiny glass sheet at a time. Rwanda’s first movie theater opened last week, in the country’s first “skyscraper” (as a New Yorker, I have to use the quotes – it’s only 12 stories tall). I’m awash in one of the world’s most wonderful feelings – the rediscovery of a place you love, the introduction to all its new parts, and the unexpected reimagination of yourself that follows. Place is important.</p>
<p>But I’m here to work, not wax philosophical.  Here’s where the chance to boss me around comes in: I’m off to South Africa shortly, for some stories about the current situation on AIDS. If you have questions you think I should ask, or things you think I should look into, drop me a line. <a href="http://www.twitter.com/itsjina">Tweet me</a>, <a href="http://www.jinamoore.com/contact/">email me</a>, or <a href="https://www.facebook.com/jina.moore">subscribe to my FB</a> feeds and send me a message.  </p>
<p>If you prefer critique to advice, follow along.  I’m feeling my way around <a href="http://instagram.com/nitwajina/">Instagram</a>, and I’ll have an occasional <a href="http://www.soundcloud.com/itsjina">radio diary</a>. I hope you’ll be patient as I find the right balance of sights, sounds and story, and I hope you’ll offer great ideas along the way.</p>
<p>Most of all, I hope that any of you running around with smartphones or sound recorders of any kind will share cool things that you hear and capture. <strong><a href="http://www.jinamoore.com/stories/">Send me your sounds</a></strong>, and let’s see what kind of aural mosaic of Africa we can make together!</p>
<p>Thanks for following along, and don’t be a stranger.</p>
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		<title>Orchid lessons</title>
		<link>http://www.jinamoore.com/2013/04/01/orchid-lessons/</link>
		<comments>http://www.jinamoore.com/2013/04/01/orchid-lessons/#comments</comments>
		<pubDate>Mon, 01 Apr 2013 22:05:18 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[Vignettes]]></category>
		<category><![CDATA[compassion]]></category>
		<category><![CDATA[flowers]]></category>
		<category><![CDATA[kindness]]></category>
		<category><![CDATA[neighbors]]></category>
		<category><![CDATA[nyc]]></category>
		<category><![CDATA[orchids]]></category>
		<category><![CDATA[spring]]></category>
		<category><![CDATA[strangers]]></category>

		<guid isPermaLink="false">http://www.jinamoore.com/?p=2744</guid>
		<description><![CDATA[When the seasons change, people in New York are electric.  They waltz across basketball courts and gun engines at red lights and dance in the street to car stereos.  They pet each other's dogs and chat across fences and look each other in the eyes as they pass each other on the street.  Sometimes total [...]]]></description>
				<content:encoded><![CDATA[<p class="first-child ">When the seasons change, people in New York are electric.  They waltz across basketball courts and gun engines at red lights and dance in the street to car stereos.  They pet each other's dogs and chat across fences and look each other in the eyes as they pass each other on the street.  Sometimes total strangers talk to each other.</p>
<p>I was encumbered walking home, two big bags over my shoulders, a hot cup of coffee in one hand, and a long orchid in a small pot in the other.  I'm house-sitting the orchid, sort of.  It was passed to me by a friend who's off working, and when I'm off working, she's going to have to take care of it for me.  This is how we work.</p>
<p>"Is that for me?" asked an elderly woman, still wrapped in winter's down, as I approached her on my block.  I realized there was no reason it couldn't be.</p>
<p>I stopped. I asked her, "Would you like it?"</p>
<p>"No," she said firmly.</p>
<p>I explained the caretaking arrangement, that everyone, including the orchid, might be glad if it had a permanent home.</p>
<p>"Still no," she said.</p>
<p>My good deed undone, I needed an exit line.</p>
<p>"Well," I said, "be careful what you ask for, I guess."</p>
<p>"Isn't that the truth," she said.</p>
<p>&nbsp;</p>
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		<title>Happy International Women&#8217;s Day!</title>
		<link>http://www.jinamoore.com/2013/03/08/happy-international-womens-day/</link>
		<comments>http://www.jinamoore.com/2013/03/08/happy-international-womens-day/#comments</comments>
		<pubDate>Fri, 08 Mar 2013 15:57:39 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[African Great Lakes]]></category>
		<category><![CDATA[Human Rights]]></category>
		<category><![CDATA[Liberia]]></category>
		<category><![CDATA[Women, War, Peace]]></category>
		<category><![CDATA[bukavue]]></category>
		<category><![CDATA[Burundi]]></category>
		<category><![CDATA[Congo]]></category>
		<category><![CDATA[DRC]]></category>
		<category><![CDATA[female genital mutiliation]]></category>
		<category><![CDATA[FGM]]></category>
		<category><![CDATA[international women's day]]></category>
		<category><![CDATA[mae azango]]></category>
		<category><![CDATA[Rwanda]]></category>
		<category><![CDATA[UN]]></category>
		<category><![CDATA[unsc 1325]]></category>

		<guid isPermaLink="false">http://www.jinamoore.com/?p=2735</guid>
		<description><![CDATA[I wish I was in Bukavu today, where I've met so many strong, amazing women fighting against not only the horrors (rape) we often hear about but against gender-based discrimination and violence, and fighting for a new way of imagining women in the world -- with their own voices, strongly and clearly sharing their own [...]]]></description>
				<content:encoded><![CDATA[<p class="first-child ">I wish I was in Bukavu today, where I've met so many strong, amazing women fighting against not only the horrors (rape) we often hear about but against gender-based discrimination and violence, and fighting <em>for</em> a new way of imagining women in the world -- with their own voices, strongly and clearly sharing their own ideas, not only about their own lives, but about the future of their country. You wouldn't think it to read the news, but Bukavu can be an inspiring place.</p>
<p>I wish I was in Kigali today, where more women make laws in Parliament than men. It was the first country in the world to achieve this distinction, and it's something deeply meaningful to other women I've met there. They may not be traditionally powerful, but they feel empowered, and you can see and hear and feel it when you talk to them.</p>
<p>I wish I was in Liberia today, as I was last year on International Women's Day, when the incredibly brave Mae Azango took on a country's deeply-held cultural ritual -- and won. Azango and I were supposed to report together on the comparatively tame topic of maternal health and midwifery. We ended up spending most of our time on a story about female genital mutilation, which she exposed in a story for her paper. It was a story no reporter wants to have told: The one where the reporter <em>becomes</em> the story because she's in danger. Azango was hiding for weeks because of threats she received for her FGM expose. Anger raged for months. But eventually, the Liberian government came forward and said, for the first time, that it wanted to ban the practice. That's a start, anyway. It was an honor and a privilege, and a deeply felt responsibility too, to report alongside Mae the very day her story broke. And it's had it's happy moments: Azango <a href="http://www.cpj.org/awards/2012/mae-azango-award-acceptance-speech.php" target="_blank">spoke powerfully</a> when she won CPJ's International Press Freedom Award in November.</p>
<p>I wish I was in South Africa today, in Port Elizabeth, with the dogged <a href="https://twitter.com/estelleellis" target="_blank">Estelle Ellis</a> and her boss, Heather Robertson.  I had the privilege to report with Ellis last year on a project about illegal abortion, for <a href="http://www.peherald.com/blog/Abortion---A-right-gone-wrong" target="_blank">The Herald</a> and <a href="www.thenation.com/article/171949/south-africa-liberal-abortion-law-doesnt-guarantee-access" target="_blank">The Nation</a>, that exposed the government's weak commitment to women's health in general.  <a href="http://pulitzercenter.org/reporting/south-africa-nelson-mandela-bay-the-herald-regional-investigative-daily-paper-heather-robertson" target="_blank">Robertson spearheads</a> <em>The Herald</em>, a no-nonsense regional paper and has, her entire career, given the government what for when they deserve it.  As it gets increasingly hard to report real news, especially about the government, in South Africa, their dedication is inspiring.</p>
<p>Where I am is New York, where the trees are heavy with wet snow that's been falling since last night.  But that's not stopping these women, who have gathered in front of the UN to demand women's rights.  Thanks to my friend Stina, who works at the UN, for sharing her photo as she headed to work this AM.</p>
<p><em>Courage</em>, as the French say, to everyone fighting the good fight.  And thank you.</p>
<p style="text-align: center;"><a href="http://www.jinamoore.com/wp-content/uploads/2013/03/women-nyc.jpg"><img class="size-full wp-image-2736 aligncenter" alt="women nyc" src="http://www.jinamoore.com/wp-content/uploads/2013/03/women-nyc.jpg" width="403" height="403" /></a></p>
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		<title>Why do we still get violence against women so wrong?</title>
		<link>http://www.jinamoore.com/2013/03/01/violence-women-wrong/</link>
		<comments>http://www.jinamoore.com/2013/03/01/violence-women-wrong/#comments</comments>
		<pubDate>Fri, 01 Mar 2013 20:30:03 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[Global Health]]></category>
		<category><![CDATA[Human Rights]]></category>
		<category><![CDATA[domestic abuse]]></category>
		<category><![CDATA[domestic violence]]></category>
		<category><![CDATA[gbv]]></category>
		<category><![CDATA[gender based violence]]></category>
		<category><![CDATA[intimate partner abuse]]></category>
		<category><![CDATA[ipv]]></category>
		<category><![CDATA[vaw]]></category>
		<category><![CDATA[violence against women]]></category>
		<category><![CDATA[women]]></category>
		<category><![CDATA[women's security]]></category>

		<guid isPermaLink="false">http://www.jinamoore.com/?p=2728</guid>
		<description><![CDATA[This week, the American Congress finally resolved its squabbles and brought itself to reauthorize the Violence Against Women Act.  It was a fight, as many others will tell you. But there's another battle still to fight, and that's how we talk about violence against women. On Thursday, TIME magazine published a photo essay by Sara [...]]]></description>
				<content:encoded><![CDATA[<p class="first-child ">This week, the American Congress finally resolved its squabbles and brought itself to reauthorize the Violence Against Women Act.  It was a fight, as many others will tell you.</p>
<p>But there's another battle still to fight, and that's how we talk about violence against women.</p>
<p>On Thursday, TIME magazine published a <a href="http://lightbox.time.com/2013/02/27/photographer-as-witness-a-portrait-of-domestic-violence/#18" target="_blank">photo essay</a> by Sara Naomi Lewkowicz.  The essay began as a project about a woman named Maggie and her boyfriend, Shane.  One night, an argument escalated to physical assault as the photographer was taking pictures.</p>
<p>The internet went crazy, blaming Sara for not trying to stop the violence -- even though she called 911.  Even though her presence probably kept Maggie safer than she might otherwise be, based on what Shane was screaming as he beat her.  Even though the police are using Sara's images to prosecute Shane.</p>
<p>At <a href="http://www.salon.com/2013/03/01/dont_blame_the_victim_or_the_photographer/singleton/" target="_blank">Salon</a>, I write a seemingly deep collective need to blame everyone but the abuser for the abuse that happened that night.  Here's a sample:</p>
<blockquote><p>Many of us are familiar with the phrase “blame the victim,” and there’s no shortage of that in the comments, at Time, on Sara’s essay. Here’s a sampling of the ideas you’ll find there: Maggie, the beaten girlfriend, should have seen this coming. Maggie stays because she likes it. Good riddance, Maggie was cheating on her then-estranged husband anyway … etc. In classic form, one insists of Maggie, “She is not the victim. She is the perpetrator.”</p>
<p>If there’s a single thing about which the critics shouting about Maggie and Sara in Time’s comment section seem to agree, it’s this: The only adult in the house during the assault who <em>isn’t </em>responsible for the violence is the man committing it.</p></blockquote>
<div data-toggle-group="story-13215794"> At the <a href="http://www.cjr.org/reality_check/documenting_domestic_violence.php" target="_blank">Columbia Journalism Review</a>, I talk with photographers, anti-gender based violence advocates, and media ethics experts about the photo essay and its presentation.  Should TIME have published where Maggie was moving to next?  Should TIME have included more information about the phone call?  Why is it viewers react so quickly, so deeply, and with much misinformation to images like this?</div>
<p>And at the <a href="http://www.theatlantic.com/international/archive/2013/03/the-pistorius-shooting-isnt-about-south-africa-its-about-domestic-violence/273637/" target="_blank">Atlantic</a>, I ask why on earth the cover story in the latest TIME magazine, about the trial of South African sports hero Oscar Pistorius for the fatal shooting of his girlfriend, talks about everything -- race, class, wealth, inequality, sports, iconography, the Truth and Reconciliation Commission -- <em>except</em> domestic violence.</p>
<blockquote><p>[TIME] says that you can't understand the Pistorius shooting -- Pistorius denies murder -- if you don't understand Cape Town. And class. And wealth disparity. And race. And sports. And -- of course -- Apartheid.</p>
<p>All of these things combine in Perry's story to explain a privileged white man's fear of an imagined assailant which, according to his defense, led him to shoot his privileged white girlfriend. The only thing that doesn't seem to merit inquiry in this American banner publication -- ironically, published within 24 hours of the <a href="http://www.nytimes.com/2013/03/01/us/politics/congress-passes-reauthorization-of-violence-against-women-act.html?_r=0">reauthorization</a> of the Violence Against Women Act -- is domestic violence.</p></blockquote>
<p>You'd have thought I'd have exhausted myself, but one thing I'm still thinking about: When is domestic violence treated, and tracked, as a criminal issue, and when it's treated, and tracked, as a public health issue, and what differences might that make?</p>
<p>Weigh in, world.</p>
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		<title>A preliminary PEPFAR roundup (and come add your ideas)</title>
		<link>http://www.jinamoore.com/2013/02/22/preliminary-pepfar-roundup-add-your-ideas/</link>
		<comments>http://www.jinamoore.com/2013/02/22/preliminary-pepfar-roundup-add-your-ideas/#comments</comments>
		<pubDate>Fri, 22 Feb 2013 12:39:06 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[Activism]]></category>
		<category><![CDATA[African Great Lakes]]></category>
		<category><![CDATA[Aid]]></category>
		<category><![CDATA[Elsewhere]]></category>
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		<category><![CDATA[Barak Obama]]></category>
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		<category><![CDATA[Pepfar]]></category>
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		<guid isPermaLink="false">http://www.jinamoore.com/?p=2712</guid>
		<description><![CDATA[On Wednesday, the Congressionally-mandated evaluation of PEPFAR -- the President's Emergency Plan for AIDS Relief -- was released.  It's nearly 700 pages long, and I haven't but skimmed its major headings.  But I'm interested in what the reaction has been, and since no one seems to have done it yet that I've seen, I thought I'd round up some response [...]]]></description>
				<content:encoded><![CDATA[<p class="first-child ">On Wednesday, the Congressionally-mandated evaluation of PEPFAR -- the President's Emergency Plan for AIDS Relief -- was released.  It's nearly 700 pages long, and I haven't but skimmed its major headings.  But I'm interested in what the reaction has been, and since no one seems to have done it yet that I've seen, I thought I'd round up some response from around the Internet.</p>
<p><strong>First, the bare facts</strong>. Dr. Robert E. Black, Chair for the Institute of Medicine Committee that wrote the PEPFAR evaluation and a professor of health at Johns Hopkins, writing in <a href="5·1 million men, women, and children worldwide.2 In fiscal year 2012, PEPFAR supported antiretroviral drugs for the prevention of mother-to-child transmission for nearly 750 000 pregnant women who were HIV positive.2">The Lancet</a>, says that as of September, PEPFAR had provided 5.1 million people worldwide with anti-retrovirals, or ARVs, drugs that slow the progress of HIV.  In 2012 alone, 750,000 pregnant women received ARVs, which prevent mothers from passing the virus on to their unborn children.  Black doesn't cite a budget figure, but the New York Times puts it at "<a href="http://www.nytimes.com/2013/02/21/health/renewal-of-aids-program-backed.html?_r=0">about $38 billion</a>."</p>
<p>The evaluation, which covers PEPFAR since its inception in 2003, took four years to prepare and includes interviews and data review from 13 PEPFAR partner countries, PEPFAR HQ, and other international HIV prevention and treatment organizations.</p>
<p><strong>Its conclusions include a few standouts</strong>. The program is generally doing a good job -- not necessarily a given, despite the numbers cited above -- but it needs to do yet more.  To reach more people, to help countries scale up and sustain their own responses, and -- here's the partisan divide's favorite part -- to do more about sex.</p>
<p>We might as well just deal with this here: Whatever boon it is to public health, PEPFAR is also political. It's a project of George W. Bush (though some people are <a href="http://www.foreignpolicy.com/articles/2013/02/14/what_george_w_bush_did_right?page=full" target="_blank">chagrined</a> you might not know that), whose name adds fire to any conversation. Fanning partisan flames is the fact that Barack Obama has proposed PEPFAR <a href="http://sciencespeaksblog.org/2012/02/13/pepfar-raided-to-meet-global-fund-pledge-in-president-obama%E2%80%99s-fiscal-year-2013/#axzz2Lb8ttW8M" target="_blank">cuts</a> for FY2013.  Like just about any other topic, PEPFAR is ripe for partisan sniping.</p>
<p>Let's agree not do any of that here, shall we?</p>
<p><strong>But we still have to talk about sex</strong>. Sexual transmission of HIV, that is.  Black writes, "Even as it maintains its support for interventions that target all modes of HIV transmission, PEPFAR should prioritise  reduction of sexual transmission. The unequivocal epidemiological evidence that sexual transmission, with underlying behavioural drivers, is responsible for most new infections is in stark contrast with the mixed availability of evidence that lends support to effective behavioural interventions for prevention."</p>
<p>In plain English, that sounds to me like Black means this: "We know that new infections from HIV come from risky sex.  Telling people not to have sex ('behavioural interventions') doesn't work."</p>
<p>How to handle the having of sex has long been a controversy.  In its first incarnation, PEPFAR funds only went to clinics that followed the ABCs -- Abstain, Be Faithful, Use Condoms.  There was controversy; just last week, though, Foreign Policy magazine contributing editor and fellow of things international Christian Caryl says we <a href="http://www.foreignpolicy.com/articles/2013/02/14/what_george_w_bush_did_right?page=full" target="_blank">shouldn't get too worked up about the sex stuff</a>. "[S]ources close to PEPFAR tell me that those restrictions have proven little hindrance on the ground."(I don't know how close those sources are to PEPFAR (or how they're close, which matters), but some sources, who were medical professionals, standing about 18 inches from my face in Rwanda in 2008 told me this was a real problem.)</p>
<p>They've since been changed, and today's "relaxed" rules (from the 2008 reauthorization bill) are that programs dealing with the sexual transmission of HIV must spend at least 50 percent of their funds "for activities promoting abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction."  That probably makes sense in Washington, but it sounds like it's questionable whether that's dealing directly enough with the frequency of sexual transmission.</p>
<p>There are, and need to be, other changes too.  Black argues that the "emergency" part of the response is mostly over, and that PEPFAR needs to find ways to support long-term, sustainable work by national governments.  That can be hard, when an AIDS prevention strategy is one of many priorities for cash-strapped countries.</p>
<p>Here are some other interesting questions being asked around the web:</p>
<p><strong>What didn't work so well?</strong>  As you might expect, some of the record-keeping is poor.  Some agencies are duplicating services.  Compliance -- med-speak for taking drugs every day -- and access to care are challenges.  HIV/AIDS may be PEPFAR's priority, but it isn't always the first thing on the minds of national government leaders every day.  (These are cribbed from <a href="http://www.nytimes.com/2013/02/21/health/renewal-of-aids-program-backed.html?_r=0" target="_blank">here</a> and <a href="https://www.devex.com/en/news/blogs/pepfar-at-10-what-s-next?mkt_tok=3RkMMJWWfF9wsRovvazJZKXonjHpfsX77OsqXKS3lMI%2F0ER3fOvrPUfGjI4ESMVlI%2FqLAzICFpZo2FFcH%2FaQZA%3D%3D" target="_blank">here</a>.)</p>
<p><strong>Which countries get how much money and why?</strong>   <a href="http://news.sciencemag.org/scienceinsider/2013/02/us-governments-aids-relief-progr.html?ref=hp#.USX-Pipc5wE.twitter">Science Magazine</a> points out the part of the report about "great disparities in how much money PEPFAR spends per HIV-infected person in partner countries. At the low end of the scale, Zimbabwe has greater than 10% prevalence of HIV and only receives $25 per infected person from PEPFAR; in contrast, Guyana, which has an HIV prevalence below 10%, receives $3842 per infected person."</p>
<p><strong>Where does all that money go (through) anyway?  </strong>The Center for Global Development is releasing its own paper (soon) looking into where PEPFAR funding goes.  In 2008,<a href="http://blogs.cgdev.org/globalhealth/2013/02/what-were-looking-for-in-the-iom-report-on-pepfar.php" target="_blank"> the CGD found</a>, "477 contractors received PEPFAR financing totaling $3.56 billion; the average organization received a reported $7.5 million and the median was $1.5 million. In this 2008 dataset, more than $2 billion (about 58% of the total) was concentrated in 25 contractors (or 5% of all 477 contractors). Nearly all of these 25 contractors were based in the US and included for-profits, non-profits, faith-based organizations, universities, and others. While $686 million was spent through academic institutions, $301 million was allocated to developing-country governments as prime partners who represented 8% of all contractors."  CGD hoped the PEPFAR evaluation might include detail on how these arrangements may have changed over time.  Watch that space.</p>
<p><strong>If America stops paying, what comes next?  </strong>This is the first point <a href="https://www.devex.com/en/news/blogs/pepfar-at-10-what-s-next?mkt_tok=3RkMMJWWfF9wsRovvazJZKXonjHpfsX77OsqXKS3lMI%2F0ER3fOvrPUfGjI4ESMVlI%2FqLAzICFpZo2FFcH%2FaQZA%3D%3D">Devex</a> highlights.  Quoting the report: "The over-reliance on external donor funding in partner countries creates funding fragility and the possibility that the HIV response would be critically disrupted if funding were to be discontinued or severely reduced."   In plainspeak, it would seem, that means that if we cut funding, there's nothing to replace those 3 million people's ARVs.</p>
<p><strong>Most Tweeted quote?</strong> It seems to me to be this, from IOM Committee Chair Black:</p>
<p style="text-align: center;"><a href="http://www.jinamoore.com/wp-content/uploads/2013/02/Screen-Shot-2013-02-21-at-11.31.53-PM1.png"><img class="wp-image-2717 aligncenter" title="Screen Shot 2013-02-21 at 11.31.53 PM" src="http://www.jinamoore.com/wp-content/uploads/2013/02/Screen-Shot-2013-02-21-at-11.31.53-PM1.png" alt="" width="522" height="114" /></a></p>
<div></div>
<p><strong>Most popular spinoff?</strong> There's a lot of people who want (you) to sign <a href="https://petitions.whitehouse.gov/petition/commit-resources-ensure-aids-free-generation/fmbm52sP" target="_blank">this</a>.  That's not an endorsement.  I'm just telling you what the social media world is doing.</p>
<p>Like I said, I've only scratched the surface. What have you seen, read, heard, or said?</p>
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		<title>ARVs made easy in Uganda?</title>
		<link>http://www.jinamoore.com/2013/02/19/arvs-easy-uganda/</link>
		<comments>http://www.jinamoore.com/2013/02/19/arvs-easy-uganda/#comments</comments>
		<pubDate>Tue, 19 Feb 2013 13:49:56 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[Global Health]]></category>
		<category><![CDATA[Uganda]]></category>
		<category><![CDATA[AIDS]]></category>
		<category><![CDATA[ARVs]]></category>
		<category><![CDATA[HIV]]></category>
		<category><![CDATA[kampala]]></category>
		<category><![CDATA[public health]]></category>

		<guid isPermaLink="false">http://www.jinamoore.com/?p=2709</guid>
		<description><![CDATA[Here's something that piqued my interest: Yesterday, Ugandan drug manufacturer Quality Chemicals announced that it's going to manufacture a single pill to replace the cocktail of anti-retroviral (ARV) drugs used to prevent the progression of HIV. A central problem in treating HIV is making sure patients take the right drugs at the right time. Public [...]]]></description>
				<content:encoded><![CDATA[<p class="first-child ">Here's something that piqued my interest: Yesterday, Ugandan drug manufacturer Quality Chemicals announced that it's going to manufacture a single pill to replace the cocktail of anti-retroviral (ARV) drugs used to prevent the progression of HIV.</p>
<p>A central problem in treating HIV is making sure patients take the right drugs at the right time. Public health professionals call this "compliance," and it's not easy. The drugs also require proper nutrition to work, and patient follow-up care. A comprehensive <a href="http://www.ncbi.nlm.nih.gov/pubmed/17941716">review</a> of long-term retention of patients on ARV treatments found programs in sub-Saharan Africa lose 40 percent of their patients by the end of the second year of treatment, mostly due to follow-up care obstacles.</p>
<p>Anything that makes it easier to treat people is surely a good thing. It's tempting to think that local manufacturing of drugs is also a good thing, but that looks a little murkier. BBC's "African Dream" series last year reported that Quality Chemicals was certified in "good manufacturing practices" by the World Health Organization in 2010. According to the BBC, the designation allows the company to sell to NGOs, but the company's biggest customer is the Ugandan Ministry of Health -- and the greatest number of drugs the MoH is buying are Indian and Chinese: 90 percent of Uganda's ARVs are still manufactured abroad.</p>
<p>Uganda's Anti-Corruption Coalition (ACC) <a href="http://www.accu.or.ug/index.php?option=com_content&amp;view=article&amp;id=679:call-to-government-to-recover-ugx-445-billion-lost-through-breach-of-contract-by-quality-chemicals-industries-ltd&amp;catid=7:in-the-media&amp;Itemid=21">says</a> the arrangement amounts to corruption. The ACC says Quality Chemicals and the government cut a deal in 2005: The Ugandan government would buy all of its ARVs from Quality Chemicals for seven years, in exchange for the company building a manufacturing plant in Uganda. To incentivize that investment, the government agreed to pay a 15 percent markup on the drugs, which were supposed to be cheaper regardless because they were manufactured locally. But because most of Quality Chemicals' stock is still imported, the ACC says the effect is that the Ugandan government is simply paying a 15 percent middleman's fee to Quality Chemicals.</p>
<p>I'd be curious to hear what others know about this, especially those living in Uganda and/or working in the health sector there.</p>
<p>Regardless, the single-pill ARV is still a ways off. BBC's Focus on Africa, which <a href="http://www.bbc.co.uk/worldservice/audioconsole/?stream=focusonafrica1900">reported</a> news of the single pill yesterday, says it's not on the market.</p>
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		<title>Farewell, sweet guinea worm</title>
		<link>http://www.jinamoore.com/2013/01/24/farewell-sweet-guinea-worm/</link>
		<comments>http://www.jinamoore.com/2013/01/24/farewell-sweet-guinea-worm/#comments</comments>
		<pubDate>Thu, 24 Jan 2013 21:05:39 +0000</pubDate>
		<dc:creator>Jina Moore</dc:creator>
				<category><![CDATA[Global Health]]></category>

		<guid isPermaLink="false">http://www.jinamoore.com/?p=2700</guid>
		<description><![CDATA[In one of the most charming bits of writing I've come across of late, Carl Zimmer offers up a "fond obituary" for the guinea worm. It's one of 17 neglected tropical diseases (NTD to us nerds) getting renewed attention -- and, in the guinea worm's case, a likely end date -- from World Health Organization. [...]]]></description>
				<content:encoded><![CDATA[<p class="first-child ">In one of the most charming bits of writing I've come across of late, Carl Zimmer offers up a "<a href="http://phenomena.nationalgeographic.com/2013/01/24/the-guinea-worm-a-fond-obituary/">fond obituary</a>" for the guinea worm.  It's one of 17 neglected tropical diseases (NTD to us nerds) getting renewed attention -- and, in the guinea worm's case, a likely end date -- from <a href="http://www.who.int/mediacentre/news/releases/2013/ntds_report_20130116/en/index.html">World Health Organization</a>.</p>
<p>That's good news from a public health standpoint, of course.  Guinea worm infections sound painful and nasty.  Even Zimmer says he "will not miss it as a disease" -- and yet -- "as an animal, it will leave a mind-boggling absence."</p>
<p>Howso?  Zimmer explains:</p>
<blockquote><p>"The guinea worms have wound themselves around human history for thousands of years. Egyptian mummies contained them. The Book of Numbers describes how the Israelites were stricken by “fiery serpents” as they wandered the desert–they, too, are believed to be guinea worms. Muslim pilgrims on the hajj suffered from guinea worm infections on their way to Medina, which led to its Latin name, which means “Little Dragon of Medina.” Greek and Persian doctors were winding the worms on sticks over two thousand years ago. It’s possible that the symbol of medicine–snakes coiled around a staff–maybe actually represent this ancient treatment."
</p></blockquote>
<p>In case that makes you nostalgic:</p>
<blockquote><p>"Of all the many remarkable things about the guinea worm, here is something particularly remarkable: this journey causes its victim no pain. It’s not a fleeting infection, either. It takes the guinea worms three to four months to become sexually mature. The males only get to be 4 centimeters long; the females reach 25 times that length. Most of that extra space in their bodies is taken up by their uterus. If people have both males and females in their body, they can find each other and mate. After this internal congress, the male guinea worm creeps off to some corner of the body and dies. The female, meanwhile, swells with progeny. Three million embryos begin to grow inside her.
</p></blockquote>
<p>It takes months for the multitudes she contains to grow to the point when they’re ready to leave their mother–and their human world. She begins her journey to ground, slithering through the connective tissue until she reaches her host’s leg and creeping down further towards the foot. Only now, over a year after taking in the guinea worms, does a person become aware of what’s been happening. The guinea worm mother pierces the skin from the inside and releases an irritant that creates a painful blister–”burning without cease” as one tropical disease expert once put it.</p>
<p>There is only one balm for this pain: water. When people splash water on the blister, the guinea worm responds by twisting into a contraction and vomiting embryos from her mouth."</p>
<p>Don't even think about yanking the thing out: The worm retracts and dies. The leg swells, and the dead worm becomes "a site of infection," which can kill the human host.</p>
<p>So what's the loss, then?  There's no treatment for guinea worm infections, Zimmer explains, save the extraction of the thing.  So eradicating guinea worm infections means eradicating guinea worm.  It means eliminating a whole species -- one about which we don't actually know that much. Zimmer enumerates the lost knowledge:</p>
<blockquote><p>"No one has sequenced the guinea worm genome. No one has used new staining technology to make its neurons light up. We don’t know how long it has infected humans, or where it came from before that. What little we do know should make us intensely curious about what we don’t know–and what we may never know."
</p></blockquote>
<p><a href="http://phenomena.nationalgeographic.com/2013/01/24/the-guinea-worm-a-fond-obituary/">Read the whole piece</a>.  It is by turns thought-provoking, terrifying and delightful.</p>
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