Yesterday http://www.hivinfo4mm.org/blog/_archives/2006/2/6/1747361.html the [him] moderator was bored by ‘AIDS road’ stories. It appears that the sex was cut out of that newswire article for Chicago readers. The full story is below.
And then here is a better African ‘AIDS road’ story from the Globe and Mail’s Stephanie Nolan. The protagonist puts professional basketball players to shame. Or he’s lying.
AIDS winding its way through China
Evan Osnos
Knight Ridder Tribune News Service
RUILI, China - This ancient road has had many names: old tea horse trail. The Burma Road. Route 320. But the label that matters most today is one that appears on no sign at all: the AIDS road.
Past truck-stop brothels and through disease-ravaged cities and villages in China's far southwest Yunnan province, this two-lane road carves the path of an HIV epidemic that is growing faster than international health officials previously thought.
This is the main road through the epicenter of AIDS in the world's most populous country, where a new national study shows that 200 people are being infected every day. It is a central artery through which sex, drugs and trade are spreading the virus into previously untouched swaths of the population, researchers say.
There are ominous precedents. Key trucking routes like this helped spread AIDS to tens of millions of people in India and Africa, the world's worst-hit regions, starting with drug users and prostitutes, then truck drivers and, ultimately, their families. As China's surging economy fuels the construction of thousands of miles of new roads, health officials, activists and frontline doctors are racing to curb the Chinese epidemic before a similar explosion occurs.
"Most Chinese people still think that only drug users and sex workers are affected," said Wang Jing, an HIV counselor in the provincial capital, Kunming, "but the fact is that the disease has begun affecting everyone."
After initially denying it had an AIDS problem, China acknowledged the full scale of the epidemic in 2003 and has made strides in embracing foreign aid, tackling drug abuse and providing medical care, AIDS experts say. But life along the road also illustrates how a shortage of state funds, the stigma surrounding the virus and widespread public misunderstanding of its spread into the wider population are threatening efforts to control the epidemic.
The largest-ever survey on AIDS in China, released Jan. 25, showed that the rate of infection is rising, with 70,000 new cases reported last year. More important, the joint study by China, the World Health Organization and the U.N. AIDS program found that the disease is moving into the general population, with a growing share of infections in pregnant women and the spouses of men who visit prostitutes - warning signs of a widening epidemic.
"Sex work is moving it toward the general population," said Henk Bekedam, the China representative for the WHO. The new infection rate, he said, showed the situation in China was "more serious than we thought."
Ground zero of China's AIDS epidemic is this remote border town, where Route 320 begins its 500-mile journey north to Kunming as an inconspicuous ribbon of dirt veering over the sleepy boundary from Myanmar.
Ruili has a reputation as China's gateway to Southeast Asia, where explorers, armies and criminals have gravitated for centuries to swap jade, arms and poppies. Some of China's earliest AIDS cases were found here in 1989, and by the mid-90s the mix of Chinese and Burmese heroin addicts and prostitutes accounted for more HIV cases than any other city in the country. When the government vowed to strike hard against prostitution, police simply closed the karaoke bars and "hair salons," sending sex workers into even darker corners of society and doing little to combat HIV.
But today Ruili illustrates China's efforts to stem the epidemic. The government has opened 10 methadone clinics to help wean addicts from heroin, and foreign-aid groups are now permitted to promote testing and condom use among prostitutes.
That new approach is on display at the Rainbow Center, a foreign-funded non-governmental organization in Kunming, where former and current drug users slip into a nondescript two-story building to spend their days together, pick up free needles and condoms, and get tested for HIV, with the assurance that they won't be arrested when they step outside, as they still are in much of China.
But China's challenge has moved beyond simply high-risk populations. The task today is educating a population that still misperceives the virus as the exclusive scourge of drug addicts and prostitutes.
The recent study estimated that China has 650,000 HIV/AIDS cases, revised from rougher estimates of 840,000. That change only reflects a better measure of how many people were infected in a limited outbreak tied to a blood-selling scheme. As the study's authors cautioned, "those new numbers should not mask the fact that HIV infections are on the rise."
That rise reflects in part the rapid growth of prostitution during two decades of economic reform, which have fueled unemployment and sent millions of peasants migrating in search of work. Chinese authorities estimate there are 3 million to 4 million women working as prostitutes in so-called karaoke bars, hair salons, massage parlors and truck stops.
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They are places such as the Chrysanthemum Inn, a dilapidated roadside shack just up the road from Ruili. A bare bulb illuminates the unheated dining room and a row of rooms - each with bare walls, a bed and a pink blanket - are marked with hand-painted white numbers: 1, 2, 3. The overloaded trucks that whine to a stop here are headed everywhere - Beijing, Shanghai and beyond.
"Are you looking for a virgin?" the lead cook asked a table of visitors. She could produce one, she said, for about $2,500. A local taxi driver snorted and countered that he could find one for $125. After lunch, the cook offered sex with a female kitchen worker for $6. But asked what it would cost for sex without a condom, she said, "No way. Not in this day and age. Everybody's afraid of dying."
To prevention specialists, that is very encouraging - far more encouraging than the experience of one counselor who recently demonstrated condom use to a group of peasants by employing a banana as a prop. When she returned weeks later, she was greeted by puzzled villagers who pointed to the banana tree, with the condom still firmly affixed on a piece of fruit, and complained that its presence had produced no noticeable benefit.
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Nowhere is prostitutes' role in the epidemic clearer than in Baoshan, a low-slung mountain town of white-tile-covered buildings, where HIV spreads mostly through sex rather than drugs, according to the local center for disease control. That means key players in the epidemic are people like 19-year-old Fangfang, who spends her evenings in a denim miniskirt, in an open-air storefront of the red-light district, trying to entice passersby into a couple of hours together for about $18. When she left her remote Yunnan hometown two months ago, Fangfang was drawn by the whispered promise of far rosier prospects than she found, she said.
"Friends had come back and told us how good the outside world is," she said. "But they tricked us."
Fangfang plans to go home soon. She will tell her family she worked at a supermarket. In the meantime, she says she uses free condoms, but complains that health workers only give her three a day, so she has to make up the shortfall with her own money. Asked if she knows how to avoid AIDS, she is quick to nod, but later admits she is short on details.
"Can you tell me," she said, "what are the ways the disease is transmitted?"
City health authorities estimate there are nearly 5,000 prostitutes like her in the Baoshan area, and they concede that, even with high-level cooperation from party officials, they don't have the money to adequately promote condoms among them.
"Last year the government spent half a million yuan ($62,000)" on AIDS prevention, said Yang Xuanmei, head of the health department's AIDS prevention program for greater Baoshan. "That might sound like a lot of money, but we're talking about 2.4 million people."
As a result, prevention efforts are patchy. The government adopted a high-profile condom distribution plan, and though condoms can be found in the rooms of the high-end Landu hotel, there are none at the Military District Inn, where drivers and laborers stay for less than $4 a night.
Moreover, things in town are about to get much more complicated. By next year, 50 miles of sleek new expressway will link Baoshan to points south. From an AIDS standpoint, the new Baolong Highway poses multiple threats: an influx of 10,000 mostly male workers, who later will scatter to their home provinces, and then a fast new road to boost traffic and speed the transfer of the virus.
The urgent task is getting the workers and drivers to use condoms, which traditionally are unpopular in China - only 4 percent of contraceptive users choose that method. The Asian Development Bank is sponsoring a project to limit and measure the rise in HIV along the new highway, hoping to raise condom use among men like 58-year-old road worker Zhang Mingzheng.
Zhang, who was carrying rocks in the fading light of a setting sun one recent night, laughed when asked if he uses condoms at local brothels. He is too old to seek out nights like that, he said.
"But the young men, sure, in the summers they go into town," he said. "And everyone knows the truth is people don't use condoms every time."
http://www.bradenton.com/mld/bradenton/news/local/13800253.htm
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Promiscuity personified, on the road in Africa
Trucker claims 100,000 conquests, but HIV changes his lifestyle
STEPHANIE NOLEN
SALGAA, KENYA -- Mohammed Ali stroked his beard and thought it over: After several minutes, he concluded that it must have been 100,000 women.
Sex, that is, with 100,000 women, in the course of his 30 years as a truck driver on the long highways that snake into the heart of Africa.
That's probably something of an overestimate -- he would hardly have had time to drive -- but it speaks to the culture in which Mr. Ali, a conservative man by nature, has spent his working life.
"There are so many women on the road and they are tempting, the way they dress is very alluring and I'm very tempted by them," Mr. Ali said frankly.
When he started driving, it was a different one every night. Then he cut back to a couple of times a month. These days, he has cut back entirely.
"Sooner or later you end up with one who is positive. I have gone with many different ones, and I'm sure not many of them are infected, but by chance or by luck I ended up with one who was positive -- it was just bad luck."
Bad luck, no question, although the odds were not in his favour. Research on the key transportation corridors in Africa has found that as many as 80 per cent of the sex workers who work those routes are living with HIV/AIDS.
Mr. Ali, 48, learned that he is infected with HIV in 2003. So he's given up the indulgence of women on the road.
Africa's trucking routes are vitally important. Air freight is too costly for the cheap consumer goods that move through the continent, so long-haul trucking carries fuel as well as the products of industry and agriculture.
These days, truckers have an HIV infection rate believed to be at least twice that of the general population, and they remain a key group for the transmission of HIV.
A few projects work with truckers. Population Services International's Corridors of Hope program targets drivers at border points across Africa, for example, with condoms, education and health care right at the truck stops.
Yet people who work in the field say that, aside from some isolated success stories, little has changed in trucking culture despite the grim swath AIDS has cut through so many countries.
"They see those people playing with fire and they get burned, and then they go to play with the same fire," Ahmed Salem, deputy chairman of the Kenya Long Distance Truck Drivers' Welfare Association, said of the drivers.
Despite the importance of truckers in the fight against AIDS, recent research suggests that little has been done to figure out why that is, or to try to change it.
A study of the trucking routes by the Strengthening HIV/AIDS Control Project, a Canadian-funded joint venture of the University of Manitoba and the University of Nairobi, found that the trucking corridor through Kenya and Uganda alone could be the site of as many as 10,000 new HIV infections in a year.
But at the same time, fewer than 10 per cent of sex workers and no transport workers were being reached with anti-AIDS programs on that corridor.
"There's lots of research and data on transport but no response," said Manitoba's Chester Morris, the lead researcher on that study. Of 3,000 sex workers at truck stops between Kampala and the Kenyan border, for example, he found that fewer than 1 per cent were being reached by AIDS intervention.
Mr. Ali said that condoms were never available, ever, in all his years on the road. Nor was there any education about AIDS. But the culture of transactional sex flourished everywhere. It wasn't considered immoral for the truckers (almost all of whom are married) to be buying sex, but rather strange and suspicious if they didn't. Men need sex, and variety is important -- that's the operating principle, he said.
Mr. Ali didn't have a chance to learn more about AIDS until November, 2003, when the truck drivers' association opened up a small outreach centre in an old shipping container parked at a truck stop outside Nairobi. He was one of the first to go for an HIV test from the public-health nurse who worked there a few days a week, intending, he said, only to set a good example.
"It was a very big shock," he said about his positive test. "But I took it very easily because I'm a truck driver and I could die any time."
And indeed, a few days spent on the road with Mr. Ali makes clear that his life is exceedingly hard. The highways across Kenya -- a vital economic link for the continent -- are so bad that the shuddering of the truck cab causes his teeth to clack together sometimes when he tries to talk.
And so, said Mr. Ali, many others look for a little company when they come off the road.
"Many truck drivers end up having HIV/AIDS because they have so many problems -- the conditions of the roads, police corruption, low wages. When you have all these problems they affect the driver psychologically, so he finds a place to have entertainment and get relief."
The transactions at the truck stops are quick and almost unspoken. Women walk between the newly arrived rigs, and when one catches the eye of a driver, he tells her where he will meet her, once he's attended to the truck.
They might have some beer, or sometimes she simply climbs up into the cab. Finances first -- he hands over 150 shillings, just over $2 -- and then sex. For an extra fee, they may spend the night together in one of the small hotels.
"There's not much conversation -- these are prostitutes, they don't need much conversation," Mr. Ali said, about the negotiations. But there is plenty of chat and laughter over beer, the best antidote to the misery of the road.
He liked Ugandan assignments best: "Uganda has the best women, they are very welcoming, very kind," Mr. Ali recalled of his days as a consumer. "Very entertaining. And a good body: middle size, not fat but with a big backside and a small waist -- and not very big boobs -- that's what Ugandan women are all about."
Truckers are what's called a disease vector -- an entry point into the general population -- because they not only frequent sex workers routinely, they also have wives or long-term partners at home, to whom they regularly return, and who often pass the virus to their children at birth.
While sex with prostitutes causes an estimated 40 per cent of HIV infections in Kenya, sex work is illegal here, as it is in most other Africa countries, and so few interventions in national AIDS strategies target sex workers. Most donor countries don't like dealing with it either; in fact, the United States AIDS funding agency, which is the largest donor to AIDS in Africa, specifically requires groups it funds to sign a pledge condemning sex work.
But Prof. Morris said that the interventions are known, and simple: "Effective treatment of sexually transmitted infections -- treat them correctly and you reduce HIV infection. Peer-led education about condom use. Greater distribution of female condoms. Have the sex worker be informed and know where to go for services." Peer education in their pilot programs quickly raised reported condom use to 90 per cent of sexual encounters, he said.
"But there is no money for a rational sex-work project."
http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20060202/TRUCKER02/TPInternational/Africa
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