Volume Ii, Issue I, Spring 2009

Articulate Undergraduate Research Applied to International Development

Volume II

Issue I

i

Spring 2009

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ar•ti•cu•late / -adj., expressed, formulated, or presented with clarity and effectiveness. -v., (of an idea or feeling) to express or state clearly.

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educate

motivate

activate

Articulate: Undergraduate Research Applied to International Development is an undergraduate scholarly journal that publishes academic papers and writings online and in-print on issues concerning international development and health care in Africa. Articulate is a sub-division and publication of the non-profit, SCOUT BANANA, which seeks to educate, motivate, and activate the public about the health care crisis in Africa. This journal will act as a forum for students to contribute to, as well as make, the debates in international development. We believe undergraduate students are a vital, untapped force to bring fresh ideas, perspectives, and concepts into the development dialogue. The challenge for them will be to express old ideas in new ways, formulate creative policies, and present solutions and best practices for combating the myths, ambiguities, and problems inherent in development work. Our goal is to spark, share, and spread knowledge for the sake of innovative change now. SCOUT BANANA Mission: To combine efforts to save lives. SCOUT BANANA seeks to build a domestic and international movement dedicated to fundamental social change in which global health is everyone’s responsibility and every individual’s human right. Articulate operates under a Creative Commons (CC) “Attribution – Noncommercial – No derivative” license. Anyone is free to make use of all materials found in this issue, as long as such use complies with the terms of the license. More information can be found at http://creativecommons.org/licenses/by-ncnd/3.0/.

issn 1943-6742

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Articulate

Undergraduate Research Applied to International Development

Volume II

Issue I

Spring 2009

Editor-in-Chief

Jonars Spielberg Michigan State University [email protected]

Editorial Board Allie Carter [email protected]

Alex Hill [email protected]

Nicholas Micinski [email protected]

Monica Mukerjee [email protected]

Faculty Advisors John Metzler, Outreach Director Michigan State University [email protected]

Mary Anne Walker, Director Michigan State University [email protected]

Peer Reviewers Dan Blue Michigan State University

Stacie Dodgson Michigan State University

Samantha Fang Harvard University

Sonya Mehta UCLA

Designer Ken Hansen Michigan State University [email protected]

The opinions expressed within this journal are exlusively those of the individual authors and do not represent the views of the editorial board, SCOUT BANANA, or any of the organization’s chapters, advisors or affiliates. Current and past issues of Articulate can be accessed at www.scoutbanana.org/articulate

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Letter From the Editor Dear Readers, With support and guidance from the Michigan State University African Studies Center, the MSU Office of International Development, James Madison College, editors, and peer reviewers, it gives me great pleasure to offer you this first issue of the second volume of Articulate: Undergraduate Research Applied to International Development. This issue comes at a time of great change and excitement – not only in the development world writ large, but also closer to home: SCOUT BANANA, this journal’s parent group, has recently garnered status as a 501(c)(3) non-profit. As SCOUT BANANA grows, so too this journal hopes to extend its capacity and reach by giving undergraduate scholars the opportunity to present their rich insights to an ever-growing global audience. In this issue, Christine Esche outlines the specious role of oil in the turbulent history of the Niger Delta region. The status quo – consisting of corrupt public officials, corporate profiteering, and a militant insurgency – debilitates any prospect for sustained development for the Delta’s industry and denizens. Christine champions a coordinated international response that she hopes will pacify this unstable, but strategically important, part of the world. Chelsea Jacobs and Scott Jelinek draw on seven weeks of field experience and research to examine the many ways in which HIV/AIDS has affected society and culture in Western Kenya. They then formulate an HIV/AIDS education and prevention program that attempts to appropriately address all effects of HIV/AIDS. Kate Settle investigates the past accomplishments and the recent decline in the success of Uganda’s ABC campaign against HIV/AIDS, and cautions against the indiscriminate application and exportation of this method to other countries. In a similar vein, Justin Lockwood critiques the President’s Emergency Plan for AIDS Relief (PEPFAR) and its effect on the allocation of resources and aid for specific types of prevention programs. He advocates for more flexibility in spending distribution and an overhaul of PEPFAR’s constitution to optimize its effectiveness. Katie Omstead considers the historical role of colonialism in three African countries and the enduring significance of historical antecedents for Africa’s present and future development. This issue also contains two reflective essays by young people who have recently spent time on the ground in Africa. Jillian Merica encounters “real meat” for the first time when she travels to Mali, and finds herself rethinking and recalculating the full and actual cost of food. This issue ends with a thoughtful and personal piece by Danice Brown, in which she explores the unexpected intricacies, large uncertainties, and small triumphs of development work. In keeping with the two issues of the first volume, this iteration of Articulate intentionally mingles academia and real-world experience. In our effort to promote reflection on current trends in international development, as well as of our own experiences, we hope that focused, determined action will not be far behind. These articles and their authors certainly leave us with many important issues to ruminate over. In turn, we would be happy to lend a listening ear to your thoughts, and would be even more delighted to learn of your recent undertakings. Sincerely, Jonars Spielberg Michigan State University July 2009

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Africa Map of Contents Morocco Merica

Uganda

Settle Omstead

Nigeria

Esche

Mali

Brown

Kenya

Jacobs & Jelinek Omstead

Democratic Republic of Congo Omstead

Sub-Saharan Africa Lockwood

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Table of Contents Foreword

1

Rita Kiki Edozie, Ph.D.

Scholarly Articles Crisis in the Niger Delta

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HIV/AIDS Prevention in Uganda

13

The Multiple Layers of HIV/AIDS Devastation in Western Kenya

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PEPFAR

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The Tarnished Pearls of Africa

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Christine Esche

Do as I Say, not as I Do Kate Settle

Exploring the Physical, Cultural, Economic, and Educational Impacts Chelsea Jacobs Scott Jelinek

An Historical Analysis of Mandated HIV/AIDS Funding Allocated to Abstinence Education Justin Lockwood A Comparative Historical Analysis of Colonial and Post-Colonial States in Africa Katie Omstead

Young People in the Field Jillian Meets Real Meat

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Integrating Values into Development

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Call for Papers

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Style Sheet

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Jillian Merica

Fouzia’s Story Danice Brown

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Foreword Volume II, Issue I of Articulate comes out at a time of intense debate about development assistance (aid) and its contributions to development outcomes in Africa. Earlier on in the year, Zambian-born development economist Dambisa Moyo published an indictment of current development policies in Africa that she claims pigeon-hole the continent into aid-dependency, a process that thereby fosters Africa’s continued underdevelopment compared to other regions of the world. Apparently, as Africa stands to lose $50 billion in development aid this year as a result of the global financial crisis, Moyo (in a BBC program debate) scoffed that she is only “superficially worried” about the harm that this will bring to Africa. In her new book, Dead Aid, she supports her dismissal of what she calls the Western “aid-industrial-complex” by advocating for greater African self-sufficiency and autonomy in financing development. Moyo also envisions a “100% aid-free” Africa in which the continent will be more integrated into the free market global economy in ways that she claims will reduce corruption, improve infrastructure, increase trade, and foster strengthened entrepreneurship. Like the rest of the development community and “Africa-friendly” organizations – such as SCOUT BANANA and MSU’s African Studies Center, who have longstanding commitments and track records in advocating and participating in African development – Articulate’s current contributors seem to be suspect about Moyo’s criticisms of development aid to Africa even while they may perhaps acknowledge the essence of her message. That is to say, the young scholars who have contributed articles about diverse development issues on the continent in the current volume appear to be more sanguine and optimistic about their roles as positive and consequential products of development assistance from the North to the South – in this case to Africa. This is because in eschewing a debate about aid solely around “economics and finance,” the articles in the current issue chronicle Africa’s dire political, cultural, and social development needs – dimensions of development that Moyo’s narrow “neo-classical, economic” narrative seems to skirt over. In doing so, the young writers and researchers of Articulate reveal the many dynamics and challenges that face the continent’s drastic health crisis, its political conflicts, and they even explore the continent’s cultural and ethical domains. These contributions demonstrate to the naysayer of aid to Africa that as the continent’s pressing development needs are underscored in this era of global financial crisis, despite the privileges that these students enjoy as citizens of the advanced industrial wealthy regions of the world, they will magnanimously continue to contribute their skills, ideas, and resources addressing Africa’s development needs. Their work offers a counter to Moyo’s critique, underscoring the fact that development assistance is not merely delivered in monetary form. Based on rigorous and creative field and academic research, the ensuing contributors to Articulate continue to utilize the journal for compiling and presenting some of the most pertinent issues and dynamics regarding Africa’s development shortcomings. Even more importantly, the current edition of Articulate will provide you with a rich potpourri of undergraduate student experiences, commentaries, and research insights that you will thoroughly enjoy reading. Indeed, contrary to Moyo’s message in Dead Aid, the undergraduate scholar-contributors of Articulate say, “Keep aid alive!” Rita Kiki Edozie, Ph.D. Associate Professor of International Relations James Madison College, Michigan State University

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Scholarly Articles

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The Crisis in the Niger Delta Abstract Since the discovery of oil in the Niger Delta, the standard of living of the general delta population has, against all expectations, plummeted. Most of the Delta’s thirty million inhabitants now live on less than one dollar a day – less than the norm under British colonial rule over forty years ago. The standard of living for Nigerians falls below that of all other major oil nations. This paper identifies the causes of this phenomenon and explores the character and grievances of the Delta’s militant uprising. It also articulates the importance of pacifying the unrest for both Nigeria and oil-importing countries, especially the United States, which relies on Nigeria for one-fifth of its oil supply. The international community must take an active role in stabilizing the Niger Delta through encouraging transparency, social betterment programs, and democracy. Militia leaders, oil companies, and the Nigerian government all profit from the status quo. Without a steadfast commitment from the international community, oil-importing countries like the U.S. will continue to be dependent on unstable regions for energy, and the Delta villagers who live in squalor will continue to suffer. Introduction Nigerians held high hopes to transform from rags to riches upon the discovery of oil in the Niger Delta in 1956. The easily refined, low-sulfur oil nicknamed “Bonny Light” that gushed from the Delta swamplands truly seemed like liquid gold. The world market craved it. Within twenty years of the oil’s discovery, Nigeria had become a member of the Organization of Petroleum Exporting Countries (OPEC). The people’s hearts swelled with hope as the government’s budget swelled with incoming petrodollars. By feeding the industrial world’s limitless appetite for oil, Nigeria would have plenty of funds to create and maintain systems for universal education and health care, reliable electricity, sanitation, disease prevention, housing projects, improved infrastructure, and more. This hope of being an inspiring success story, however, quickly crashed in the face of the nightmarish reality. Most of the Delta’s thirty million inhabitants now live on less than one dollar a day – less than the norm under British colonial rule over forty years ago. Infuriated by the government’s corruption and the oil companies’ blatant disregard for the Nigerian people’s well-being, the bitter young men of the Delta have taken to arms, forming decentralized militias that have practically turned the Delta into a war zone. The costs of ignoring or intensifying this unrest are dangerously high for both Nigeria and oil-importing countries. This is especially true for the United States, which imports onefifth of its total oil supply from Nigeria. The U.S., in cooperation with the international community, must work with the Nigerian government to address the root causes of these insurrections. The Curse of the Black Gold “Port Harcourt should gleam; instead, it rots,”1 comments National Geographic 1 Tom O’Neill, “Curse of the Black Gold: Hope and Betrayal in the Niger Delta,” National Geographic 211.2 (Feb 2007): 89-112.

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reporter Tom O’Neill. Port Harcourt is the capital city of Rivers State, and is also a center of oil extraction in the Delta. Rivers State receives by far the largest amount of federal allocations among Nigerian states – a total of $894 million annually.2 In a city that should be gleaming from such generous funding, O’Neill reports that “dense, garbage-heaped slums stretch for miles. Choking black smoke from an open-air slaughterhouse rolls over housetops. Streets are cratered with potholes and ruts. Vicious gangs roam school grounds. Peddlers and beggars rush up to vehicles stalled in gas lines. There is no electricity, no clean water, no medicine, and no schools.”3 Every sector of society suffers from lack of maintenance. The Port Harcourt airport is still shut down from a 2005 accident involving a plane plowing into a herd of cows that had wandered onto the runway. High crime rates and the absence of reliable police compel shops and restaurants to hire guards with AK-47s for protection. Vanity Fair reporter Sebastian Junger notes that “A dead man lay on the street near his hotel for two days before someone finally came to take him away. Even during Liberia’s darkest days of civil war, the dead were usually gathered up and buried faster than that.”4 Villagers die of easily treatable diseases, and fatal car accidents are frequent due to lack of road repair since the 1980s. Standing in the slums of Bandu-Waterside, which lie on the outskirts of Port Harcourt, a priest and Ijaw rights activist President Owei laments, saying, “With the wealth that Nigeria has, the whole nation should have roads and free education.”5 This is not the case: Amongst so much affluence, Nigerians find themselves living in squalor. The environmental impact of the oil industry has crushed the Delta’s traditional economy. Port Harcourt used to be a self-sufficient fishing community, but since the oil boom, oil spills, acid rain, and the stripping of mangroves have killed the fish, leaving the fishermen unemployed and the community starving. Unable to fish, villagers try to land jobs with oil companies, but have little success even if they hold degrees in petroleum engineering. Port Harcourt, like the rest of Nigeria, has gone from self-sufficiency to importing more goods than it produces, including fuel. Due to Nigeria’s broken down oil refinery infrastructure, even as a major oil producer, gas stations often run dry.6 The United Nations has recently discovered that, despite an estimated $60 billion annual national revenue from oil, the standard of living for Nigerians falls below that of all other major oil nations. Its annual per capita income of $1,400 is less than that of Senegal, which exports mostly fish and nuts.7 Ever since the first oil extraction in the Oloibiri village (about 50 miles west of Port Harcourt) just before independence, five major multinational oil firms – Royal Dutch Shell, Total, Agip, ExxonMobil, and Chevron – have “transformed a remote,

2 Darren Kew, State-Level Politics: Governors, Godfathers, and the Politics of Greed, State Department Conference on Nigeria, 2006. 3 O’Neill, 89. 4 Sebastian Junger, “Blood Oil,” Vanity Fair (Feb 2007): 112 ff. 5 Junger, 115. 6 O’Neill, 89. 7 Ibid.

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nearly inaccessible wetland into industrial wilderness.”8 This industrial wilderness has ravaged the ecosystem with 4,500 miles of pipelines, 159 oil fields, 275 flow stations, constant gas flares, and over 7,000 oil spills. Fifty thousand acres of mangroves have disappeared over the course of seventeen years time due to oil and gas exploration.9 The oil industry has been quickly and callously destroying the environment that the Delta communities have historically relied upon for their economy, food, and drinking water. “I can say this,” Isaac Asume Osuoka, director of Social Action, Nigeria, said firmly. “Nigeria was a much better place without oil.”10 The Perils of Corruption Foreign oil companies practice pernicious behavior that fuels tensions in the Delta. Many, for instance, have been accused of paying off local youth gangs. Agip of Italy allegedly offered $40 million to the Movement for the Emancipation of the Niger Delta (MEND), a chief militia group of the region. Halliburton has admitted to paying $180 million in bribes to the Nigerian government.11 House Representative William Jefferson of Louisiana, who was found with $90,000 cash in his freezer, is under FBI investigation for accepting bribes from former Vice President Atiku Abubakar in exchange for oil contracts. The United Nations Development Program and the International Crisis Group report that oil companies are paying off village chiefs for drilling rights; building a road or dredging a canal without an adequate environmental impact study; tying up compensation cases – for resource damages or land purchases – for years in court; dispatching security forces to violently break up protests; patching up oil leaks without cleaning up sites;12 and more. Delta militias target the foreign oil industry and cast a great deal of blame on it for its corruption and exploitation. Corruption in the Nigerian government, however, is arguably the greatest cause of the Niger Delta’s deplorable state. Government corruption is a sickness that plagues all of Nigeria. The Niger Delta is a region that is blatantly and seriously infected with this disease. State governments primarily serve as patronage machines13 for governors and other powerful individuals – providing public goods and services is low on their list of priorities. As a result, very little state revenue ever trickles down to the people. The Niger Delta states, in particular, should be making great improvements in public services with the recent sharp rise in global oil prices. The Rivers State made nearly one billion dollars in 2006, yet public goods and services development remained stagnant.14 This gap between increasing government funds and motionless social developments leads to one conclusion: much of the state budgets are being stolen. Governor Sir Peter Odili accounts for the missing money by claiming that it is four times more expensive to build roads in the swampy conditions of Rivers State than in more agreeable climates. 8 Ibid., 91. 9 Ibid., 93. 10 Ibid., 90. 11 Russell Gold, “Halliburton Ex-Official Pleads Guilty in Bribe Case,” The Wall Street Journal, September 4, 2008, A1. 12 O’Neill, 91. 13 Ibid. 14 Ibid.

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While this may be true, it does not explain away the near total lack of public benefit gained from the one billion dollars of revenue earned in Rivers State that year. It also does not explain why Governor Odili, amidst his penny-pinching in order to save up for difficult road construction, found it necessary to buy himself two passenger jets with public funds. Similarly, it does not explain why the governor’s office requires ten percent of the total budget to run itself (for a total of nearly $100 million in 2006). Across the country, the World Bank stipulates, Nigeria’s oil wealth gets siphoned off by only one percent of the population.15 Since independence in 1960, between $300 and $400 billion of oil revenue has been stolen or misspent by corrupt government officials – an amount of money approaching all the Western aid received by Africa in those years.16 On paper, Nigerian federal law distributes oil revenue to the Delta states in such a way that would reasonably provide for the most basic social services. Once the money arrives at the governor’s office, however, it disappears. All but five of Nigeria’s governors have been accused of massive corruption. One of the most infamous government criminals is Diepreye Alamieyeseigha, who embezzled hundreds of millions of dollars as governor of Bayelsa State. After fleeing to England, he was arrested for money-laundering, jumped bail, and slipped back into Nigeria dressed as a woman. When asked how he successfully flew to Nigeria after English authorities confiscated his passport, he replied that he did not know, and that “All the glory goes to God.”17 This single example of governor corruption is repeated across Nigeria, accounting for a great deal of the destitution and despair in the Delta. In 2003 alone, seventy percent of oil revenue was stolen or wasted – a total of $14 billion.18 For a tiny portion of that stolen money, every person in the Delta could be provided with a mosquito net, and then one in every four children under five years old would no longer die of malaria.19 Delta’s 30 million people, who struggle on less than one dollar a day and die by the age of fifty, respond to this squandering of funds that could radically benefit their lives by resorting to raw violence. After independence, the Nigerian youth hoped to achieve greatness, but were instead struck down by a military take-over in 1966. At the return to democracy in 1999, Nigeria’s youth once again dared to hope for lives of dignity and security; however, as Michael Watts of the University of California says, “Those hopes have been almost everywhere violently snuffed out. The youth are pissed off and willing to up the ante.”20 The Opposition Continues On November 10, 1995, Ken Saro-Wiwa and eight other anti-Shell activists were hanged for murder on President Abacha’s orders. Saro-Wiwa was a leader in the Movement for the Survival of the Ogoni People (MOSOP), which fought 15 Junger, 114. 16 Ibid. 17 Ibid., 117. 18 Michael Watts, “Empire of Oil: Capitalist Dispossession and the Scramble for Africa,” Monthly Review 58.4 (Sep 2006): 1-16. 19 Belinda Otas, “Breathing life into Niger Delta clinics,” BBC Focus On Africa Magazine, Nigeria (Dec 2008), http://news.bbc.co.uk/2/hi/africa/7790320.stm. 20 O’Neill, 95.

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environmental degradation caused by the oil industry and the uncompensated appropriation of Ogoni land for oil drilling. MOSOP demanded a greater voice in future oil exploration and $10 billion in royalties and compensation from Shell. Ignored by both Shell and the government, Saro-Wiwa headed a mass protest that successfully halted all oil extraction in Ogoniland. Junger recalls that this was not only a severe blow to the oil industry, but also to the system of corruption and patronage it had spawned.21 The military reacted brutally, destroying thirty villages, arresting hundreds of protestors, killing an estimated two thousand civilians, and arresting top MOSOP leaders under the pretext of murdering four Ogoni chiefs during the chaos. Saro-Wiwa was rushed through a show trial and hanged. His last words were “Lord take my soul, but the struggle continues.”22 Indeed, the struggle does continue. In 1998, using MOSOP as a model, Ijaw activists declared Ijaw land off limits to the military and to oil extraction in a rebellion they called Operation Climate Change. Predictably, the military stormed in and killed dozens of civilians. In retaliation, Ijaw militants destroyed oil wellheads in their territory, and are now, for all intents and purposes, outside of military control (and often bribe military personnel to help them transport bunkered oil, which is illegally stolen from pipelines). In 2004, an Ijaw leader named Mujahid DokubuAsari, founder of the Niger Delta Volunteer Force, declared all-out war against the government and the oil companies, a statement which helped drive oil prices above $50 per barrel for the first time ever.23 Asari contends that one way for the people to take back their oil revenues is to steal it. Bunkered oil accounts for ten percent of all exported Nigerian oil and also provides underground work for those with petroleum extraction degrees who cannot find jobs with the oil companies.24 The Movement for the Emancipation of the Niger Delta (MEND) is much more than a replica of Saro-Wiwa’s MOSOP or a low-level bunkering group. MEND is a serious obstacle. When asked who the members of MEND were, the spokesman replied, “We are not communists or even revolutionaries. We’re just extremely bitter men.”25 This bitterness that stems from the inexcusable destitution and environmental degradation they suffer through is a strong fuel with which to power their cause: to totally destroy the capacity of the Nigerian government to export oil.26 They want total control of the oil in their territory. To achieve their goals, MEND kidnaps foreign oil workers, educates them about the Delta people’s plight, and then releases them after receiving large ransoms. MEND also bunkers a great deal of oil and swarms and attacks targets in speedboats in order to severely disrupt production. Due to MEND and other Delta militias, out of a capacity of 2.3 million barrels of oil per day, the multinational companies are only able to extract between 600,000 and 800,000.27 Artificial price hikes have so far been able to more or less compensate for

21 Junger, 116. 22 Ibid. 23 Ibid. 24 Ibid. 25 Ibid., 115. 26 Ibid., 112. 27 Ibid., 113.

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the loss of income, but this tactic is quickly losing ground.28 MEND certainly has a long way to go before any of its goals are met; however, as one ex-hostage notes, “They know exactly what they’re doing. The army will never have a chance.”29 The consequences of the insurrection in the Niger Delta are far-reaching for both the Nigerian state and the international community. The Nigerian military cannot protect the Delta. Shell alone has nearly four thousand miles of pipelines in the creeks along with ninety oil fields and seventy-three flow stations.30 Unable to protect it all, bunkering and sabotage are virtually unstoppable. The only real power the military has, therefore, is that of retribution. For example, in response to the killing of one soldier on the outskirts of Port Harcourt, troops swept into the shantytown and burned down every structure except a bank. Days later, stunned residents wandered through the charred ruins like ghosts; some 3,000 had lost their homes.31 Over and over again, Delta villages suffer from raids, killings, and general brutality by the military after MEND and other militia groups carry out their activities. In its attempt to end the uprisings, the military spends many resources in vain and prolongs a cycle of hate through its violence against civilians. As the military increases its violent attacks in the Delta villages, the number of civilians that take up arms also increases. The violence has also spread into the cities. In 2006, thirty militants ran their speedboats into Port Harcourt, killed eight soldiers, robbed a bank, and escaped. In May 2007, an American oil executive was fatally shot as he sat in his car in Port Harcourt traffic.32 By October, after ransoming more than fifty hostages and suffering from a twenty-five percent cut in onshore oil production, the Nigerian government found it had lost nearly one billion dollars every month due to the uprisings, and that the Niger River Delta was teetering on the brink of all-out war.33 Unrest in the delta triggers a circle of violence that harms both civilians and the military, threatens the security of an ever-expanding area, and costs the government an astonishing amount of money, which, if saved and spent properly, could be used to help the Delta’s impoverished citizens. State Strategic Concerns and International Roles The United States expresses deep concerns over the Delta conflict, but not necessarily as an expression of empathy for the plight of Nigeria’s impoverished. The U.S. runs on oil. As competition from developing states increases, oil prices skyrocket, and reserves dry up, and the U.S. becomes more and more vulnerable to the global market’s fragility. The U.S. faces grave consequences from the unrest in the Niger Delta. Currently, the world consumes 84 million barrels of oil a day, and it

28 Stephen Smith, “Nigeria and Military Rule: Will the ‘Men on Horseback’ Enter the Political Arena Again?” (presented at a seminar co-sponsored by the State Department’s Bureau of Intelligence and Research (INR) and the National Intelligence Council in Washington, D.C., October 5, 2006). 29 Junger, 117. 30 Ibid., 113. 31 O’Neill, 95. 32 Junger, 113. 33 Ibid.

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is estimated that by 2018 we will consume 120 million barrels a day.34 Since Nigeria is the U.S.’s fifth-largest oil supplier, a crisis in the Delta has the power to spike oil prices and send America into deeper recession – just as the previous two recessions were triggered by spikes oil prices. As former C.I.A. director and current Secretary of Defense Robert Gates notes, “The economic and national security risks of our dependence on oil – and especially on foreign oil – have reached unprecedented levels.”35 Barely seven months after making this statement, an incident verified Gates’ fears. In January 2006, several MEND militants attacked a Shell oil facility in the delta and captured four Western workers. MEND’s handiwork in this skirmish alone caused a 250,000-barrel-a-day drop in production and a boost in world oil prices. MEND released the hostages and stated its demands several weeks later: the release of two incarcerated Ijaw leaders, $1.5 billion in compensation for environmental damage to the Delta, fifty percent ownership of all oil pumped in its territory, and development aid to Delta villages. With no sign of these demands being met, the United States could assume continued war against the oil industry.36 Sure enough, one month later, MEND captured an American barge and with it nine hostages. That same day, MEND also blew up two pipelines and a tanker-loading terminal. These actions cost Shell 477,000 barrels a day in exports.37 The hostages were returned in exchange for hefty ransoms, while world oil prices climbed further upwards. In a world that guzzles nearly 90 million barrels of oil every day, whose demand is rapidly increasing in appetite, and that has already used up half of its proven, exploitable oil reserves, MEND has been making a frightening impact. The U.S. State Department has officially recognized Nigerian oil as a strategic national interest since 2002, and therefore reserves the right to send in U.S. troops in order to maintain order in the region. Experts fear that further crisis in the delta paired with an extremely harsh winter or a terrorist attack in the Persian Gulf could send the United States into a major recession.38 The United States, along with other energy-hungry states like India, China, and South Korea, have a huge stake in the Delta. The international community must take an active role in stabilizing the Niger Delta through encouraging transparency, social betterment programs, and democracy. Foreign oil companies have been searching for a way to cooperate with communities in the Delta ever since their establishment. Unfortunately, negotiations with village leaders are often illegitimate due to uncertainty regarding who has the authority to grant the rights to drill. Thus, the projects are never completed, leaving water tanks without operating pumps, clinics with no medicine, schools with no teachers or books, fishponds with no fish.39 Of course, greed and corruption continue to be constant obstacles to decent business behavior. Unable to rely on the oil companies or the Nigerian government to sort out the crisis on their own, the international community has had several ideas for how to protect its important investments in the Niger Delta. It has been suggested to the 34 Ibid., 118. 35 Ibid., 112. 36 Ibid. 37 Ibid. 38 Ibid., 118. 39 O’Neill, 91.

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U.S., UK, France, and Italy that they pressure the government to institute resourcecontrol reforms and negotiate in good faith with Niger Delta groups,40 and also pressure oil companies headquartered in their state to be transparent about revenue and payments. They should also lobby India and China to sign the Extractive Industries Transparency Initiative, which aims to increase transperency of payments by companies to governments. The Western powers with vested interests in the delta should also offer assistance to the Nigerian government in creating transparent state budgets. Granting creative multilateral debt relief to those states that commit to demonstrable progress could encourage this transparency. The United States has been urged to consider delaying or postponing cooperation with state governments that “have a poor record for delivering public services or controlling graft, and [to] not work with government or party officials who provide weapons or funding to armed groups for political purposes.”41 When asked about the prospects of international influence successfully reforming the Nigerian government, human rights activist Oronto Douglas replied, “It’s going to be tough. Nobody who has privilege surrenders it easily.”42 For this reason, and others, the United States military has stepped up to the plate. Lobbyist Paul Michael Wihbey argues for U.S. military intervention in the troublesome oil-producing states. Given the growth of the United States’ oil operations in the Delta, Wihbey finds it only rational for the U.S. to strengthen the region’s maritime security. Doing so, he argues, will quell short-term problems like piracy, bunkering, sabotage, and kidnapping.43 Nigeria has agreed to collaborate with and share the costs of U.S. military operations in the Delta. Wihbey estimates that a mere $10-20 million investment on the U.S.’s part will be sufficient to realize tangible benefits. Indeed, during the May 2006 African Seapower Conference in Abuja, Admiral Harry Ulrich acknowledged that U.S. ships were patrolling Nigerian oil fields within a limit of two hundred miles. He defended the Navy’s actions, saying, “We are concerned for Nigeria and we want to help her protect the region from the hands of the maritime criminal. In all parts of the world, the U.S. and any good nation want a safe coast for countries who are supplying their energy and that is why we are often there.”44 While the U.S. is tangled in the quagmire that is Iraq, no large-scale invasion of the Niger Delta is on the horizon; however, the U.S. military presence in the region shows no sign of disappearing as long as the United States’ energy security depends on imported oil. Despite the short-term benefits that U.S. military aid can provide, militarization without government and oil company reform will fail to bring longlasting stability to the Niger Delta, and, consequently, to its supply of oil exports. 40 International Crisis Group, “The Swamps of Insurgency: Nigeria’s Delta Unrest,” Africa Report No. 155 (3 Aug 2006), http://www.crisisgroup.org/library/documents/africa/west_africa/115_the_swamps_ of_insurgency_nigeria_s_delta_unrest.pdf. 41 Ibid. 42 Junger, 115. 43 J. Stephen Morrison, “The Gulf of Guinea and U.S. Strategic Energy Policy” (presented as a testimony statement before the Senate Foreign Relations Subcommittee on International Economic Policy, Export and Trade Promotion in Washington, D.C., July 15, 2004). 44 P. Lubeck et al., “Convergent Interests: U.S. Energy Security and the ‘Securing’ of Nigerian Democracy.” Center for International Policy (Feb 2007), http://www.ciponline.org/NIGERIA_FINAL.pdf.

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Conclusion While it is clear that Nigeria will not solve this problem on its own and that this problem must be solved, it remains unclear as to how this will be achieved. Militants can try to force reforms with violence, the international community can try to democratize the region through diplomacy, and the United States can send in the military to protect oil facilities, but many argue that in the end, it is all about money, and consequently the situation will never improve, and the victims most affected – the Delta villagers who live in fear and poverty – will continue to suffer. From the perspective of militia leaders, and the oil companies, and the government, the status quo is the most lucrative option. The easiest way to bunker oil is to bribe someone into permitting theft. Low-paid Nigerian soldiers often take the bribe (usually around $100 per month) and militia leaders get millions of dollars worth of oil in a matter of months. One bunkerer claims, “The federal government could easily stop bunkering if it wanted to, but local officials are making so much money off it that they would revolt.”45 The government and oil companies like Shell, which accused sloppy bunkerers as the ones who are causing the oil spills, are able to evade paying the incalculable costs of cleaning the Delta and providing clean water for villagers. Then, they are able to continue oil extraction without regard for the environmental impact. The violent crimes of the militias give the governors an excuse not to allot money for social programs, leaving more for them to spend on personal luxuries. All this leads Junger to conclude that “Under the current system, everyone involved in the oil business – from corrupt government officials to military commanders to the militants themselves – makes vastly more money than he would in a transparent economy.”46 Other than the impoverished millions of the Delta, only the United States and other oil-importing countries will benefit directly from stabilizing the region. If the international community hopes to democratize and reduce corruption in the Niger Delta, it has a long, arduous task ahead. In the meantime, though, the people of Port Harcourt will continue struggling through life on their one dollar a day, as corrupt officials and multinational oil corporations continue to make their millions. Christine is a recent graduate of the University of Wisconsin-Madison, where she completed a Bachelor of Science in International Studies. She can be contacted at [email protected]. Works Cited Otas, Belinda. “Breathing life into Niger Delta clinics.” BBC Focus On Africa Magazine, Nigeria (Dec 2008). http://news.bbc.co.uk/2/hi/africa/7790320.stm (accessed June 12, 2009). International Crisis Group. “The Swamps of Insurgency: Nigeria’s Delta Unrest,” Africa Report No. 155 (3 Aug 2006). http://www.ciponline.org/NIGERIA_FINAL.pdf 45 Junger, 116. 46 Ibid., 117.

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(accessed May 17, 2008). Gold, Russell. “Halliburton Ex-Official Pleads Guilty in Bribe Case.” The Wall Street Journal, September 4, 2008, A1. Junger, Sebastian. “Blood Oil.” Vanity Fair (Feb 2007): 112 ff. Kew, Darren. State-Level Politics: Governors, Godfathers, and the Politics of Greed. State Department Conference on Nigeria (2006). Lubeck, P., M. Watts, and R. Lischutz. “Convergent Interests: U.S. Energy Security and the ‘Securing’ of Nigerian Democracy.” Center for International Policy (Feb 2007). http://www.ciponline.org/NIGERIA_FINAL.pdf (accessed May 17, 2008). Morrison, J. Stephen. “The Gulf of Guinea and U.S. Strategic Energy Policy.” Presented as a testimony statement before the Senate Foreign Relations Subcommittee on International Economic Policy, Export and Trade Promotion in Washington, D.C., July 15, 2004. O’Neill, Tom. “Curse of the Black Gold: Hope and Betrayal in the Niger Delta.” National Geographic 211.2 (Feb 2007): 89-112. Smith, Stephen. “Nigeria and Military Rule: Will the ‘Men on Horseback’ Enter the Political Arena Again?” Presented at a Seminar co-sponsored by the State Department’s Bureau of Intelligence and Research (INR) and the National Intelligence Council in Washington, D.C., October 5, 2006. Watts, Michael. “Empire of Oil: Capitalist Dispossession and the Scramble for Africa.” Monthly Review 58.4 (Sep 2006): 1-16.

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HIV/AIDS Prevention in Uganda: Do as I Say, Not as I Do Kate Settle

Abstract As the workforce dwindled and more children were left orphaned, Uganda needed to act quickly against HIV/AIDS. Beginning in 1986, President Yoweri Museveni led Uganda in the world’s most substantial rate decrease seen to date. By the mid-1990s, other Sub-Saharan nations joined Uganda in its efforts to prevent the virus’ transmission. Many of the other countries used Uganda’s ABC method (Abstinence, Be faithful, and Condoms) as a blueprint for their own country, but none of them have experienced the same rate decrease. More recently, in 2006, however, HIV transmission in Uganda began to increase. Since many African countries followed Uganda’s lead, it is vital for researchers to investigate why HIV/AIDS is again on the rise. This is accomplished by analyzing the initial HIV/AIDS rate decrease and comparing findings with current policies. The ABC program was instrumental, as was acknowledging local cultural values, such as polygamy and community mobilization etiquette. However, the influx of foreign funds, the focus on abstinence, and the public’s complacency has contributed to the increase of HIV/AIDS patients in Uganda today. Other countries in Africa must note what went wrong in Uganda and devise their own plan of action to successfully minimize the transmission of HIV/AIDS. Introduction During a 1998 visit to Sub-Saharan Africa, President Bill Clinton applauded Ugandan President Yoweri Museveni for championing the development of a successful HIV/AIDS prevention campaign, hailing him as part of “a new generation” of African leaders.1 As evidence grew that the country’s so-called “ABC” program – an acronym meaning Abstinence, Be faithful, and Condoms – was successfully reducing Uganda’s HIV/AIDS, other Sub-Saharan countries sought to emulate its program. Unfortunately, none have yet enjoyed a level of success commensurate to that of Uganda. In fact, a recent increase in Ugandan HIV/ AIDS cases has many health officials questioning whether the ABC program is even still helping the country that pioneered it. Though experts agree that the program deserves recognition for engaging civil society at every level, many worry that the meddling of international benefactors is stamping out this very vitality, reducing experimentation and even quashing the implementation of certain prevention techniques that have been shown to reduce transmission, such as the distribution of condoms. Can the ABC program be credited with the initial decline in Ugandan HIV/AIDS prevalence? If so, is the program an exportable model for HIV/AIDS prevention in sub-Saharan Africa? Given both, what explains the program’s declining influence, and how can it be revitalized? The answers to these questions will have an outsize influence on whether a branch of the ABC program will once again constitute an effective model of HIV/AIDS prevention, and, for better or worse, will 1 N. Poku, and A. Whiteside, The Political Economy of Aids in Africa (Aldershot: Ashgate, 2004), 167.

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substantially impact the future of Sub-Saharan Africa. Uganda Confronts a Crisis Several decades ago, a mysterious illness meandering along the shores of Lake Victoria in southern Uganda earned the name “slim disease” because it caused rapid weight loss and eventual death.2 The same problem soon plagued other, wealthier nations, which quickly allocated money for research. The HIV virus was then discovered, and in 1982, the first documented case reported in Uganda tied it to the “slim disease” epidemic, now known as AIDS.3 The epidemic quickly reshaped the region. It was not until 1986, when the Ugandan civil war finally ended and President Museveni consolidated power, that a major HIV prevention program was implemented.4 President Museveni recognized how AIDS permeates society at every level – individual, family, communal, and national – and that it is one of the largest barriers to development in Sub-Saharan Africa. The costs for the public-sector tax the government, but the costs of declining efficiency also tax society at large. AIDS targets the most productive segment of the community, the young, and forces elders to redirect their energy from economic activity to caretaking of sick and orphaned family members. The significance of this phenomenon cannot be overstated in Uganda because it is home to the largest absolute number of orphaned children in the world, over one million, largely due to parents dying from AIDS.5 Within the health sector, already-thin funding must be stretched further, affecting not only costly chronic diseases like AIDS, but also basic primary care services. The availability of doctors and nurses is even more dangerously stretched because training specialized labor forces requires development, even in the best of times. Farm lands are also ignored, leading to the desertification of fields. The cumulative effect of these problems is often a massive ecological disaster that worsens food security. What is more, at the very time when the country requires outside resources, private companies begin to head for the door, fearful of the infrastructure problems and reduced productivity that the disease causes.6 With all of these issues in mind, President Museveni opted for a swift and comprehensive HIV/AIDS control strategy in the early stages of the epidemic.7 2 Michael H. Merson et al. “The history and challenge of HIV prevention.” The Lancet 372.9637 (August 8, 2008): 478. 3 Poku and Whiteside, 169. 4 Marta Zaccagnini, “HIV and AIDS in Uganda” (August 27, 2008), Avert, http://www.avert.org/aidsuganda.htm. 5 Anne-Christine D’Adesky, Moving Mountains (London: Verso Books, 2006), 144. 6 Alan Whiteside, HIV/AIDS (Oxford: Oxford University Press, 2008), 70. A study by the Boston University’s Center for International Health and Development (CIHD) tracked the productivity of AIDS patients at a Kenyan tea plantation and found that HIV-infected individuals picked on average 5.1 kilograms of tea less per day than workers not infected with HIV. 7 Uganda AIDS Commission. “The Multi-Sectoral Approach to AIDS Control in Uganda: Executive Summary” (Kampala: The Ugandan AIDS Commission, 1993), 2.

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Implementing the ABC Program There is widespread consensus that Museveni’s early action against HIV/AIDS was instrumental. He quickly realized that the Ministry of Health was an inadequate actor to address the HIV/AIDS crisis, because the disease’s rippling effects stretched beyond the medical arena. In retrospect this was a wise decision: by 2002, there were over 1,000 separate actors involved in Uganda’s HIV/AIDS prevention.8 Museveni began this widespread synchronization process in the early planning stages, including a task force in 1986 that received input from various government ministries, nongovernmental organizations (NGOs), and faith-based organizations about how to empower the citizenry. Uganda’s leaders quickly realized that they needed to educate their citizenry if they were to rein in the spread of HIV/AIDS. Wisely, Ugandan leaders did so by engaging people on a grass-roots level. Uganda pioneered reducing stigma, bringing discussion of sexual behavior into the public, involving HIVpositive individuals in the national conversation, encouraging Voluntary Counseling and Testing (VCT), improving the status of women, including faith organizations, and enlisting traditional healers.9 As Nana Poku notes, it is striking that Uganda’s “community and political efforts have reinforced each other, yet the impetus still comes from the community level.”10 This has allowed the program to evolve in response to the people’s changing needs. The national Task Force on AIDS soon led to the creation of the Uganda AIDS Commission in 1990. By planning locally and dispensing plausible recommendations to lower the incidence of HIV/AIDS, they outlined the multi-sectored strategy that eventually reduced Uganda’s infection rate. Among other things, the group was uniquely capable of accounting for regional cultural variance that outsiders might unknowingly downplay, as well as building commitment from the populace. Officials determined that social marketing was an effective way to bring information about HIV/AIDS prevention methods to individuals.11 As such, pop culture outlets were deployed to build awareness and counter stigma and discrimination surrounding the disease. For instance, comic books would include HIV-positive characters to reach young audiences. This background allowed people to be more open to learning about HIV/AIDS and how to prevent it and made them more likely to pursue treatment, when necessary. This bottom-up approach was essential because changing the public mindset and motivating people to act was the only viable way to get a handle on the AIDS epidemic. To be clear, discrimination still remains, and is even institutionalized in certain ways. For example, HIV-positive soldiers in the military cannot be promoted, and at one point Museveni himself insinuated that his political opponent 8 Uganda AIDS Commission. “Overview of HIV/AIDS Coordination” (Kamapala, Uganda: Uganda AIDS Commission, 2002). 9 Susan A. Cohen, “Beyond Slogans: Lessons From Uganda’s Experience with ABC and HIV/AIDS,” The Guttmacher Report on Public Policy 6.5 (December 2003): 2. 10 Poku and Whiteside, 172. 11 Helen Epstein, The Invisible Cure (New York: Farrar, Straus, and Giroux, 2008), 194.

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was infected with HIV.12 Such discrimination dissuades the public from seeking testing, treatment, and other services. Without question, however, great strides have been made since the 1980s, especially in comparison to neighboring countries; one author noted how mentioning AIDS during a taxi cab ride will yield a much more open response from a driver in Uganda than in Kenya.13 Officials realized that changing people’s sexual behavior was the most effective and efficient way to prevent the transmission of HIV. Thus, the first letter in the ABC acronym stands for “Abstinence.” By encouraging people to increase the age at which they first experience intercourse, or to choose abstinence after previous sexual encounters, they knew that they could reduce HIV/AIDS’ transmission. Even if convincing people to completely abstain from sex was not possible, experts knew that if Ugandans had fewer sexual partners, the odds of transmission would decrease significantly. As such, they pushed for people to “Be faithful.” The program encouraged people to limit their sexual contact to a single partner, without moralizing such behavior. This intensely pragmatic focus can be seen in one of the earliest government campaigns, “Zero Grazing,” which began in 1986.14 The policy drew its name from the shape created by a cow eating while tied to a tree. The premise was that Ugandans did not have to abandon multiple sexual relationships to help curb the rise of AIDS; rather, the key was to reduce the number of regular sexual partners and to eliminate casual encounters as much as possible. The World Health Organization noted that from 1989 to 1995 the number of Ugandan men reporting three or more non-marital sexual partners dropped from 15% to 3%.15 The third, and most controversial, aspect of the ABC program was the widespread promotion and distribution of condoms, which help protect against HIV/AIDS infection. Condoms were not heavily distributed in the early years of AIDS, because Museveni felt that they offered false hope that the epidemic could be stopped without curbing multiple sexual partnerships.16 Once citizens were noticeably adjusting their behavior and it became clear that condoms were an effective prevention technique, however, the domestic government and international groups began to advocate for their use.17 By the mid 1990s, Uganda emerged as the model for HIV/AIDS prevention in Africa.18 As the international community took greater notice of Uganda’s mounting success, funding picked up and ears opened. This is not surprising, as the national 12 Zaccagnini. 13 Poku and Whiteside, 174. 14 Epstein, 193. 15 Zaccagnini. 16 Ibid. 17 Cohen, 2-3. A note on condoms: abstinence-only supporters criticize condoms as an excuse to not curb sexual habits, yet they have been proven to help reduce the likelihood of transmission. Furthermore, not all sexual encounters are consensual, so educating the public to be prepared serves to diminish the possibility of contracting HIV/AIDS and decreasing unintended pregnancies. A shift towards salubrious reproductive health coincides with lower HIV prevalence rates. 18 Whiteside, 109.

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HIV/AIDS prevalence steadily declined from 20% in 1991 to 6.5% in 2000 – an unprecedented and, unfortunately, still unmatched feat.19 Additionally, between 1990 and 2002, the national infection rate for pregnant women fell from 31% to 4.7%.20 The country received a great deal of funding from NGOs, and in 2003, the United States included the country on its list of fifteen countries eligible to receive funds from the “Presidential Emergency Plan for AIDS Relief ” (PEPFAR). A plan to distribute fifteen billion dollars worth of aid over the next five years, PEPFAR was heralded as a watershed chance to more broadly implement the lessons of the previous two decades. PEPFAR emerged at an opportune moment, occurring concomitantly with significant medical advancements, notably the advent of antiretroviral drugs (ARVs). A recognized treatment option for those with AIDS, PEPFAR helps fund ARVs for a significant percentage of Ugandan patients. Moreover, a donation of medicine from German pharmaceutical manufacturer Boehringer-Ingelheim worked to significantly reduce vertical mother-to-child transmission (MTCT) of HIV.21 Uganda appeared to be on the right track as it entered the twenty-first century. Limitations of the ABC Program Despite Uganda’s success and optimism, the disease’s incidence reduction came to a halt as prevalence remained stagnant from 2001 through 2005.22 Then, in 2006, the HIV/AIDS rate began to increase and steadily continues to rise to the present day. This upward trend was noticed only after several nearby countries, such as Botswana, adopted similar ABC-based AIDS control strategies. A public and academic debate quickly ensued to determine what caused the reversal of the downward infection trend. Some conclusions are in consensus among the international community, but others remain hotly contested. One of the more contentious findings is that mortality inadvertently bolstered Uganda’s statistics. Even though prevention programs were initiated early, treatment programs were not. ARVs were not a feasible option at the time, due to their early stage of development and exorbitant price until 2004, when the government began to offer them for free.23 Consequently, many infected individuals from the initial surge of HIV/AIDS in the 1980s experienced the end of the disease’s survival period and died. In 2000, the Ugandan health ministry estimated that 800,000 people died of an AIDS-related illness since the beginning of the epidemic.24 Maria Wawer, a public health researcher from Columbia University, estimates that “Death alone accounted 19 UN Millennium Project, “Prescription for healthy development: increasing access to medicines,” Report of the Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines, Working Group on Essential Medicines (Sterling, VA: Earthscan, 2005), 125. 20 Whiteside, 9. 21 D’Adesky, 146. 22 Zaccagnini. 23 Ibid. 24 Ibid.

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for a six percentage point reduction in HIV prevalence in one year [2001-2002].”25 Even though this only accounts for a fraction of Uganda’s “success,” it cannot be attributed to government intervention. As a result, the full extent of HIV reduction was somewhat lower than previously believed. When evaluating what increased the HIV prevalence in Uganda, this information is invaluable, because it is beneficial to know accurately the extent in which the program was effective. From here, one can analyze the real actors responsible for increasing the HIV/AIDS rate in Uganda. One of the largest contributors is society’s growing complacency with regard to the disease. It has derailed prevention programs and extensively contributed to recent infections. By 1995, 91.5% of men and 86.4% of women knew somebody that died from AIDS, hence swift community mobilization was spurred by fear.26 “AIDSfatigue” resulted from a general exhaustion due to the constant barrage of socialmarketing in towns and schools and from a changing perception of AIDS. Originally, an HIV-positive test result was a death sentence, but that changed with the increasing distribution of ARVs, most notably when they began to be offered free of charge in 2004.27 ARVs are very effective at extending life and increasing its quality, which led people to view AIDS as a treatable disease, hampering the success of prevention programs. The lessening dread has resulted in increased complacency with control efforts.28 In consequence, a noticeable upward trend back to multiple sexual partners has emerged, such as the higher proportion of men with two or more partners rising 25% to 29% from 2000 to 2005.29 This behavior reversal has contributed to the rise of HIV prevalence. Another key problem with the existing ABC model is that foreign money has convoluted its original mechanisms. All three aspects of the ABCs program were designed by and for Ugandans to complement one another. However, money is so desperately needed that monetary aid has substantial influence over the planning and initiation of new and continuing projects. Bush’s PEPFAR earmarks encapsulate this debate. While only one billion of the fifteen billion dollars was officially allocated for abstinence-only programs, PEPFAR fails to acknowledge that the success of Uganda could be attributed to anything other than abstinence.30 Yet, there is no evidence that abstinence-only education had any significant effect in Uganda from 1988 to 1995.31 Furthermore, all abstinence-only campaigns ever studied have failed to convince

25 Bob Rochr, “Abstinence programmes do not reduce HIV prevalence in Uganda,” Boston Medical Journal (March 5, 2005): 496. 26 R. L. Stoneburner and D. Low-Beer, “Population-Level HIV Declines and Behavioral Risk Avoidance in Uganda,” Science 304.5671 (April 30, 2004): 716. 27 Zaccagnini. 28 Merson et al., 485. Throughout Africa, there are five new HIV cases for every two patients placed on ARVs. 29 Zaccagnini. 30 Epstein, 186. 31 Cohen, 2.

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individuals to delay sexual encounters.32 From 1988 to 2001, the national HIV rate declined 70%, but the average age at which women began sexual activity rose less than a year, a nugatory value.33 Furthermore, condoms are currently promoted less within schools and health care visits than they were in the last decade. A large reason for this shift is because clinics are more likely to receive needed funds if they mention their promotion of abstinence-only programs in grant proposals through PEPFAR.34 Groups in dire need of financial backing mold their program to fit the wants of foreign donors. “PEPFAR really shifted the emphasis to A and B just because of the amounts of money being put into these programs,” Sam Okware, a senior Health Ministry official and architect of Uganda’s ABC model, notes.35 This impedes the full potential effectiveness of local organizations and NGOs that spearheaded the initial success of the ABC program. Specifically, agenda-setting money has eliminated the original campaign of Zero Grazing, which contributed significantly to the decline in HIV incidence. When social marketing that advocated Zero Grazing proliferated fifteen years ago, Catholic and Protestant ministries supported government efforts. Only with the influx of Evangelical Christian NGOs and foreign financial capital did the population begin to criticize the program for moral reasons. This has served to hold Uganda back from realizing Zero Grazing’s full impact. While promoted, people with non-regular sexual partners declined by 60% from 1989 to 1995.36 Donors need to accept that there is a firm distinction in Uganda between monogamy and respectful loyalty to partners. Zero Grazing yielded results because it allowed individuals to curtail risky sexual habits instead of requiring an all-or-nothing pledge, like abstinence, which is less likely to be maintained. However, as a consequence of evangelism, it is improbable to expect the social climate within and outside of Uganda to reclaim a policy recognizing polygamy, both formal and informal, as normative and legitimate.37 Even if Uganda does not reinstate Zero Grazing, its effectiveness stemmed from its formation and implementation from the bottom up. Perils of a Pre-Packaged ABC Program Tensions flare when outside officials try to use the current ABC model in other countries. To begin, the country’s leadership has an outsize influence on a solid prevention strategy. Museveni, as previously stated, confronted the HIV/AIDS outbreak quickly and with considerable effort. He spoke about the disease often to the public, discussed options with government ministries, and initiated radio and television ad campaigns.38 Citizens were well informed about the consequences of 32 Epstein, 186. 33 Ibid. 34 Zaccagnini. 35 Ibid. 36 Poku and Whiteside, 170. 37 Epstein, 196. 38 PBS, “Uganda: A Complicated Success Story,” PBS (May 30, 2006), http://www.pbs.org/wgbh/

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ignoring HIV/AIDS at an early stage in the epidemic. Other countries have not had leaders as astute as those in Uganda. South Africa, for example, receives convoluted messages from the government; there, confusion remains as to the cause of AIDS and its threat.39 As a result, the nation is plagued by denial and inaction. For the state to act against the surge of new HIV infections, an adroit leader is a necessary actor. Simply mimicking the ABC strategy facilitates a president or prime minister to skirt necessary duties. Assuming a state has a dynamic leader already, there are still two main problems with emulating the ABC program. First, the model has evolved away from its original comprehensive approach within the last five years. According to Stephen Lewis, the UN Special Envoy for HIV/AIDS in Africa, PEPFAR’s emphasis on abstinence above condom distribution is a “distortion of the preventive apparatus and is resulting in great damage and undoubtedly will cause significant numbers of infections which should never have occurred.”40 Second, Uganda reversed the HIV rise with a bottom-up approach. Transplanting the ABC program elsewhere automatically negates the significance of community mobilization. Botswana, for instance, studied the effectiveness of the ABC method, but its results differed significantly from Uganda. Researchers found that much of the ABC message was getting through, but little difference was made in effective behavioral change because the program lacked context-specific content.41 In order to implement successful programs, governments must work with community leaders and organizers to devise a strategy that includes local socio-cultural values. Zambia successfully implemented this facet. The HEART program (Helping Each Other Act Responsibly Together) was designed for and by youth to promote abstinence and condom use.42 Researchers found that adolescents exposed to HEART’s message are 46% more likely to stop or delay having sex and 67% more likely to use a condom the last time they had sex compared to those not exposed to the program.43 Even though community mobilization is a painstaking process, it cannot be overlooked; the foundation of any country’s HIV/AIDS prevention strategy must be firmly rooted in local contexts. Another shortcoming of the ABC method, even in its earlier and more comprehensive form, is the neglect of HIV testing and male circumcision. Testing is needed on the bureaucratic level for statistical analysis and on the individual level for treatment options. It was initially conducted voluntarily at local facilities, but soon shifted to “opt-out” strategies that were able to better serve the national stage.44 Health workers take all blood samples submitted for medical lab work and test for pages/frontline/aids/countries/ug.html. 39 Stoneburner and Low-Beer, 717. 40 David Brown, “Africa Gives ‘ABC’ Mixed Grades,” Washington Post, August 15, 2006, A section, A04. 41 Ibid. 42 Cohen, 2. 43 Ibid. 44 Zaccagnini.

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HIV/AIDS unless the patient chooses to “opt-out.” This technique has proven to have a higher capacity in terms of the number of samples tested, but voluntary counseling and testing (VCT) programs are able to serve the immediate community more significantly. Individuals are less likely to change their behavior if news of infection is relayed through a secondary communications source than given in person, because the local channel allows easier follow-up care and counseling to encourage infected individuals to be pro-active in treatment and prevention.45 Uganda has applied this aspect with success. A survey asked participants where they first learned about AIDS and 82% of women reported a personal communication channel.46 To reduce the prevalence of HIV/AIDS in any country (Sub-Saharan or globally), VCT programs must play an important role. Even though it is not included in the iconic “ABC” acronym, it must not be neglected. In addition, male circumcision has very recently entered the scene. Only in 2007, published studies showed that circumcision protects men in heterosexual sex from contracting HIV.47 Engaging in a sexual activity with somebody that is HIV/ AIDS-positive is not an automatic guarantee that the disease will be contracted. Circumcision reduces the likelihood that an unaffected person will attain HIV/AIDS 50% to 65% lower given there is some form of sexual contact. Encouragingly, surveys have concluded that the majority of men in Uganda are open to the procedure.48 Countries planning a HIV/AIDS prevention policy must not neglect to include testing and male circumcision into their strategy. Ugandan policies do incorporate these features, but donors, especially PEPFAR funds, often fail to acknowledge that other aspects and considerations of Uganda’s program have had an instrumental effect in Uganda’s success of the 1990s. Conclusion The ABC approach succeeded because it was comprehensive; abstaining from sexual encounters was only one component. Faithfulness entailed being loyal to however many regular sex partners one had, not just a marital partner. Condoms were encouraged for casual sex, as well as in marriage as a precaution. The early ABC campaign catalyzed an unprecedented decline in HIV infections due in large part to coordinated action with civil society and local community actors. “Ugandans managed their epidemic, took credit for success, and national and international policy provided support, rather than the other way around.”49 Some foreign funding, however, has negatively influenced Uganda’s HIV/AIDS control method. PEPFAR has marginalized the broad nature of Uganda’s ABC program and placed an unjustified emphasis on abstinence. This happened concurrently in select countries attempting to 45 Poku and Whiteside, 184. 46 Stoneburner and Low-Beer, 715. 47 Donald J. McNeil, Jr., “Circumcision’s Anti-AIDS Effect Found Greater than First Thought,” New York Times, February 23, 2007, Section A, Column 1, Foreign Desk, pg. 3. 48 Ibid. 49 Poku and Whiteside, 182.

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use the ABC method as a model for their own country. Outright imitation has proved ineffective and also risks causing significant damage to other HIV/AIDS prevention efforts. Neighboring governments should instead survey their own population to devise a successful program, for truly emulating Uganda’s program requires extensive synchronization with the public. More advanced science and an informed international public can also be used as constructive pieces in new HIV prevention plans, although both are secondary to social cohesion. The environment in Uganda in which the ABC approach flourished cannot be replicated, but this should not deter other Sub-Saharan nations. The next generation of African leaders has yet to make its mark. Kate is currently a junior at Lewis & Clark College, where she is working toward a Bachelor of Arts in International Affairs. She can be contacted at [email protected]. Works Cited Brown, David. “Africa Gives ‘ABC’ Mixed Grades.” Washington Post, August 15, 2006, A section, A04. Cohen, Susan, “Beyond Slogans: Lessons from Uganda’s Experience with ABC and HIV/AIDS.” The Guttmacher Report on Public Policy 6.5 (December 2003). http://www.guttmacher.org/pubs/tgr/06/5/gr060501.pdf (accessed August 28, 2008). D’Adesky, Anne-Christine. Moving Mountains. London: Verso, 2006. Epstein, Helen. The Invisible Cure. New York: Farrar, Straus, and Giroux, 2008. McNeil, Jr., Donald J. “Circumcision’s Anti-AIDS Effect Found Greater than First Thought.” New York Times, February 23, 2007, Section A, Column 1, Foreign Desk, pg. 3. Merson, Michael H., Jeffrey O’Malley, David Serwadda, and Chantawipa Apisuk. “The history and challenge of HIV prevention.” The Lancet 372.9637 (August 8, 2008): 475-488. PBS. Uganda: A Complicated Success Story. PBS (May 30, 2006). http://www.pbs.org/wgbh/pages/frontline/aids/countries/ug.html (accessed June 12, 2009). Poku, N., and A. Whiteside. The Political Economy of AIDS in Africa. Aldershot: Ashgate, 2004.

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Rochr, Bob. “Abstinence programmes do not reduce HIV prevalence in Uganda.” Boston Medical Journal 330.7490 (March 5, 2008): 496. Stoneburner, R.L., and D. Low-Beer. “Population-Level HIV Declines and Behavioral Risk Avoidance in Uganda.” Science (April 30, 2004): 714-718. Uganda AIDS Commission. “The Multi-Sectoral Approach to AIDS Control in Uganda: Executive Summary.” Kampala: The Uganda AIDS Commission, February 1993. Uganda AIDS Commission. “Overview of HIV/AIDS Coordination.” Kamapala, Uganda: Uganda AIDS Commission, 2002. UN Millennium Project. “Prescription for healthy development: increasing access to medicines.” Report of the Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines, Working Group on Access to Essential Medicines. Sterling, VA: Earthscan, 2005. Whiteside, Alan. HIV/AIDS. Oxford: Oxford University Press, 2008. Zaccagnini, Marta. “HIV and AIDS in Uganda.” Avert. http://www.avert.org/aidsuganda. htm (accessed August 27, 2008).

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The Multiple Layers of HIV/AIDS Devastation in Western Kenya Exploring the cultural, economic, and educational impacts inflicted by HIV/AIDS Chelsea Jacobs Scott Jelinek

Abstract The physical problems associated with HIV/AIDS can be so striking that the cultural, economic, and educational implications are often overlooked. Upon visiting Western Kenya, we learned the degree to which HIV/AIDS affects people and society at all levels. HIV/AIDS has become so ingrained in Kenyan society that it is now part of the fabric of the culture. While investigating the impact of HIV/AIDS on the clients of Opportunity International we found that the vast majority of clients knew someone with HIV/AIDS, and nearly ninety percent were financially supporting someone who had contracted HIV/AIDS. Testing centers are readily available and free, yet few people have a solid understanding of the virus and even fewer are tested. Physical, cultural, economic, and educational effects combine to form a vicious cycle that with each turn amplify the rampant spread of HIV/AIDS. Our proposed program, which was designed to educate clients on HIV/AIDS, was formulated based on the field-tested assumption that the knowledge and empowerment gained from education has the power to break such a vicious and devastating cycle. Introduction There are at least two sides of Kenya: one is represented by the beauty of Lake Victoria, the other by the terror of HIV and its insidious, innocuous spread on the lake’s shores. Billions of dollars of foreign aid is being given to those in need, but huge disparities persist. HIV/AIDS is now the fourth leading cause of death in lowincome countries and the sixth worldwide, becoming a significant health crisis in several parts of the world.1 Responding to this crisis comprehensively is imperative. Recent responses and world understanding of the disease are mostly a reaction to the physical aspect of HIV/AIDS. However, we believe that other aspects of the disease cause the most harm to Western Kenya’s society. For many Kenyans, the physical effects of HIV/AIDS are not the most devastating or frightening effect; rather, it is the socioeconomic impact on families and loved ones. Although we were told varying reports from a wide range of sources, it appears that close to 40% of people in Western Kenya, mainly the Nyanza province, are infected with HIV. Although this statistic is devastatingly high, we found that the impact of HIV/AIDS on those not infected was significantly more detrimental than the infection rate illustrates. Our research was driven by the possibility that current HIV/AIDS aid programs were not addressing fully each aspect that HIV/AIDS affects. We were fortunate enough over our seven-week stay in East Africa to hear many personal stories told to us by clients of a leading microfinance organization, 1 U.S. Overseas Cooperative Development Council, “Cooperatives Help Fight HIV/AIDS,” http://www. ocdc.coop/OCDC/hivaids.html.

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Opportunity International – Wedco Ltd. (OI), while we were conducting fieldbased research for the organization. We surveyed over 800 clients and interviewed 162 individually. We encountered a large variety of types of businesses, age groups, demographics, and family dynamics. Of those that we interviewed, 58% were female and 42% were male and ages ranged from 22 to 62 with the average age being 37.7 years old. Using the knowledge acquired from speaking with the clients, we created a database that categorizes the different ways in which HIV impacts the clients of this microfinance organization. Those whom we interviewed were just a step above extreme poverty, many living on barely a $1.00 a day.2 The clients were all receiving small loans (from USD$50 to $500) from OI. In Kenya, OI uses a system called “trust banks” that takes advantage of the clients’ sense of loyalty stemming from the largely collectivistic culture. Instead of loaning money to an individual, OI gives loans to self-selected groups of 18-20 individuals. If one person defaults on their weekly repayment, the responsibility to repay the loan falls to the other group members. It is difficult to have a client be loyal to an outside organization, but if one’s friends and family members are burdened with repaying one’s loan, OI found that a client is much more likely to repay. In our research, we were specifically looking at four separate but integrated dimensions of impact: physical, cultural, economic, and educational. We learned that although the physical impact is the most conspicuous characteristic of the disease, compared to the other aspects of the disease, the physical impairments have the fewest number of long-term effects. As the interviews progressed, it became apparent that for the families and communities affected by HIV/AIDS, the impact was much larger in the three other dimensions. HIV/AIDS has had a devastating effect on the population of Kenya, killing an estimated 1.5 million people since 1984.3 We learned of school-aged children as young as twelve who were forced to drop out of school due to the need to bring additional income to their families. We also learned of women who had to sell their bodies for additional income since they were not making enough at their day jobs. It was saddening to talk to these women who were so full of life, energy, and passion, but who were also subject to demeaning practices such as temporary prostitution, often trading sex for fish in the Lake Victoria region. What was most disheartening of all was the glimmer of hope that was present in many eyes, yet that hope was not enough to change their lives for the better. The lack of resources and empowerment makes it almost impossible for women to better their circumstances. Because of the diesase’s encompassing nature, we believe that HIV/AIDS does more than ravage the body. Though the physical impact is great, the cultural, economic, and educational impacts of the disease cannot be neglected. By speaking to clients of OI, we came to understand the needs of the clients, and subsequently addressed those needs through a preventative HIV/AIDS education program. 2 Global Monitoring Report 2008, “MDGs and the Environment - Agenda for Inclusive and Sustainable Development,” The World Bank, http://web.worldbank.org/WBSITE/EXTERNAL/EXTDEC/EXTGLOBALMONITOR/EXTGLOMONREP2008/0,,contentMDK:21709297~menuPK:4860412~pageP K:64168445~piPK:64168309~theSitePK:4738057,00.html. 3 Mark Mascolini, “Over half of HIV+ Kenyan children in dire need of antiretovirals,” International AIDS Society, http://www.iasociety.org/Default.aspx?pageId=5&elementId=10530.

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Physical Impacts There are three typical stages associated with HIV/AIDS. In the infection stage, which lasts up to two months, the human immunodeficiency virus (HIV) is virtually undetectable and rapidly replicates. Antibodies are not yet formed during this stage, making the virus more likely to be spread. HIV tests check for these antibodies, and because antibodies are not present at this stage, one can be infected and not test positive. The second stage, or the asymptomatic stage, can last years, even a decade or more. We encountered many people who had not been tested for HIV/AIDS because they did not “feel sick.” Although the average development of HIV to AIDS (Acquired Immune Deficiency Syndrome) is ten years, “severe under-nutrition impairs immune function and thus reduces resistance to infections. Similarly, the pathogenesis of HIV infection leading to AIDS may be accelerated in individuals with specific nutrient deficiencies, coexisting infections, and suppressed immune functions.”4 In America, if one is eating healthily, it is possible for HIV never to develop into AIDS. In Sub-Saharan Africa, where one’s daily diet mainly consists of corn and where many people lack sufficient vitamins, the virus develops more rapidly. This is one reason why the infection rates in Kenya and many other African countries are devastatingly high. Indeed, more than two-thirds (71%) of those living with HIV/ AIDS in the world live in Sub-Saharan Africa. More specifically, “Most of those living with HIV/AIDS are in food deficient countries of East Africa, especially rural areas. Nutrition is one of the most immediate needs of an HIV/AIDS infected person to extend life and is critical to any anti-retroviral drug treatment or mother-to-child transmission (MTCT) prevention program.”5 It is impossible for a mother or child to benefit from the anti-retroviral drugs (ARVs) if they have poor nutrition; not only do they not work, but they can also make the individual even sicker and could lead to death. The Red Cross in Kenya recognizes that “life-prolonging ARV drugs have been labeled ‘death drugs’ because of the effect they have on patients who take them without adequate food.”6 The terrible side effects of taking ARVs without the proper amount of food prevent a significant amount of people from receiving treatment. AIDS is the autoimmune disease caused by HIV, and AIDS is the final stage of HIV infection in which opportunistic pathogens invade the body.7 Indeed, a person does not die of AIDS alone: often, it is tuberculosis or malaria that finally defeats the weakened body of its victims. One woman that we met was so weak that she could not mix her HIV and TB medications, forcing her doctors to put her on an eight-month dose of TB medication. The only problem was the woman was only four months into the treatment and her body was so damaged from HIV that it was difficult to imagine her living another four months without the ARVs. 4 Max Essex et al., AIDS in Africa, Second Edition (New York: Kluwer Academic/Plenum Publishers, 2002), 417. 5 U.S. Overseas Cooperative Development Council, “Cooperatives Help Fight HIV/AIDS,” http:// www.ocdc.coop/OCDC/hivaids.html. 6 PlusNews, “Kenya: Food Shortages Complicating ARV Programme in the North,” http://www.plusnews.org/Report.aspx?ReportId=74162. 7 Encyclopædia Britannica, “AIDS,” Encyclopædia Britannica Online, http://www.britannica.com/eb/ article-225030.

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Cultural Impacts The reverberating effects of HIV/AIDS on those who are not infected themselves are devastating. Almost 100% of clients that we spoke to knew someone in their immediate family or a close friend who has HIV/AIDS. From this data, it can be inferred that HIV/AIDS is pervasive throughout the entire Nyanza province. Indeed, the disease has permeated society to such an extent that the culture has adapted to include it in its very fabric. From our interviews, we found that the general level of awareness was shockingly low, especially for an area that is so overwhelmingly impacted by HIV/AIDS. Most clients reported knowing of the services provided by Voluntary Counseling and Testing centers (VCTs), but many lacked the education to understand how HIV is spread or even what it means to get tested. Reports show that only 17% to 18% of Kenyans know their HIV status, even though all testing services and antiretroviral medications are theoretically free.8 The largest deterrent to getting tested for HIV/ AIDS is people’s fear that the test will only lead directly to death. Unfortunately, there is a perceived relationship between testing and death because people often wait until it is too late to get tested and start treatment. If tested early enough, it is likely that, with the proper diet and drugs, one can live quite a long and healthy life. People also question why they would get tested when they are “not sick.” It is often misunderstood that one can have HIV, and also be asymptomatic. Many assume that, because they “feel fine,” they do not have the disease and therefore continue infecting others due to their lack of awareness and condom use. Another common fear arose from the lack of knowledge about the actual testing process. By simply describing the testing process to clients, they were encouraged to get tested. The lack of knowledge in the Nyanza province only fosters an environment in which HIV continues to spread due to risky behaviors. Ironically, in the Kisumu area (the capital of the Nyanza providence), a woman is 50% more likely to contract HIV if she is married than if she is sexually active and unmarried.9 The common perception is that if a woman refuses sex or demands condoms with a boyfriend and he does not listen, she can easily leave him and find another man. On the other hand, if she is married, she often has no ability to decide if she has sex or not, since she is normally at the will of her husband. The Luo tribe, which is the main tribe in Western Kenya, is, as we were told on several occasions, “obsessed with sex.” Wives are expected to sleep naked, so that their husbands can have sex with them whenever they so desire. Some also believe that sex with young virgin girls will purify those who are already infected with HIV.10 Since this, obviously, is not medically true, it leads to the further spread of the disease. These sexual practices are so ingrained in the culture that even those who are better educated about the disease will often participate in such practices. Moreover, a married woman is often not the only person who has sex with her 8 Center for Disease Control, “Global HIV/AIDS,” http://www.cdc.gov/nchstp/od/gap/countries/ kenya.htm. 9 Ibid. 10 International Federation of Red Cross and Red Cresent Societies, “Brave Few Challenge HIV/AIDS Stigma in Kenya,” http://www.aegis.com/news/ifrc/2001/IF010702.html.

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husband. Polygamy is widespread in Western Kenya, with male clients often having up to three wives. Married men also commonly have girlfriends. Therefore, the first wife will often not demand condoms, knowing that her husband will satisfy his need elsewhere if she refuses. Both genders expressed fear in even asking for condoms, believing that it would arouse suspicion. Such a demand could also be perceived as accusing their spouse of cheating, which could cause unwanted arguments. The Luo tribe has the highest prevalence of HIV, which is largely due to their multiple sex partners.11 They are also a high-risk population due to the other sexual practices previously mentioned. Economic Impacts In a report to the U.S. Congress, the United States Agency for International Development (USAID) recognized that the “most immediate impact [of HIV/ AIDS] is financial.”12 Unlike most other diseases, HIV/AIDS strikes men and women during their most productive years and the “loss of income, savings, and productive assets jeopardizes the family’s survival.”13 The death of a family member dramatically decreases the family’s income, or totally eliminates it if the deceased member was the sole provider. Any savings that the family has are quickly depleted in an attempt to provide for the family and cover medical costs and funeral expenditures that can be several times more than the average household income.14 It is increasingly clear that HIV/AIDS is becoming more and more associated with poverty. Not only do clients have their own survival expenses to worry about, but also the extra burden of taking care of additional children is thrust upon most families when a loved one dies of AIDS. We found that 88% of the clients we interviewed were financially supporting someone with HIV/AIDS (including orphaned children), and 72% were taking care of orphaned children, averaging 3.1 children per family. Throughout Kenya, 890,000 children have been orphaned by AIDS,15 emphasizing the impact that orphans have on families. Some costs of taking care of orphans include school uniforms, books and supplies, and food. Most families cannot afford an extra bed or mosquito net, so it usually means fitting an extra child into an already overcrowded bed. In some cases, up to twelve children were observed sharing one room, with some straws mats and blankets that were certainly not enough for all twelve. Fortunately, the notion of family in Kenya is a very fluid term: Those who are barely genetically related will often adopt a child orphaned by AIDS. We also observed that many women turn to sex for money as their “fall back” option when they become financially desperate. In interviews with female clients, one thing that we heard repeatedly was the story of feeling trapped, of being unable to maintain a profitable business if they do not have financial support (e.g., from 11 Vinod Mishra et al., “Education and Nutritional Status of Orphans and Children of HIV-Infected Parents in Kenya,” USAID, http://pdf.dec.org/pdf_docs/PNADD 695.pdf. 12 UNDP, “Millennium Development Goals: A Compact Among Nations to End Human Poverty,” Human Development Report 2003, http://hdr.undp.org/en/reports/global/hdr2003/. 13 Ibid. 14 Ibid. 15 Kenya AIDS Watch Institute, “Alarm Over AIDS Orphans,” http://www.kenyaaidsinstitute.org/ presscolumn.html.

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husbands, microfinance NGOs). HIV/AIDS causes and magnifies economic hardship within families that forces people – primarily women and young girls – into temporary prostitution for support, which in turn only causes them to become more vulnerable to infection. Temporary prostitution is a common way to earn the extra income needed to sustain a household. Women, who have small jobs, such as selling vegetables on the streets, make insufficient incomes. Often, this is not enough to pay for food for the family. Thus, once a week or once a month, they will have sex for money. These women would never call themselves prostitutes; rather, they see it as a way in which to supplement their income. Since it has been shown that men will pay twice as much for sex without a condom, it is easy to see how tempting it is for women in dire financial straits to agree to unprotected sex. Unfortunately, this contributes to the increased rate of HIV among prostitutes, which further spreads the virus. The women who are most likely to participate in temporary prostitution are likely to only have a one-room home. Therefore, their children see their mother having sex from extremely young ages and become desensitized to promiscuous sex. The extent of child prostitution in Kenya is astounding, especially in Kisumu. Often girls are forced to stop their education and help support their families financially.16 Because they have often been raised around sex from a very young age, they do not fully understand the concept until they begin participating. During a health talk given to a group of 12-13 year old girls, it was observed that most of them did not understand the concept of rape or did not know that there was a difference between consensual sex and rape. One 13-year-old girl said that if a father rapes his daughter it must have been the daughter’s fault, as she must have invited the sexual advances by not wearing enough clothing. The young girl also showed no qualms about the concept of forced sex. Generally, it is not considered rape if a girl’s boyfriend forces sex upon her. The only time forced sex is considered rape is if a stranger rapes a girl, and even then it is often blamed on the girl. Another common practice is for young girls to have “Sugar Daddies,” older men who tempt them with presents until they agree to have sex. This is disconcerting, especially when a 2005 survey of HIV prevalence among people aged 15 to 19 by South Africa’s Human Sciences Research Council reported that “women with partners at least five years older were four times more likely to be HIV-positive than women with partners nearer their own age.”17 In the Western Kenya region, we found that HIV is an extremely pressing issue: 38% of adult women are infected with HIV/AIDS, as compared to the national average of 6.7%.18 One of the reasons why the Nyanza area of Kenya has one of the highest infection rates in all of East Africa is because of its close proximity to Lake Victoria. While truck drivers are one of the main causes for the spread of HIV/AIDS across the continent of Africa, in East Africa, it is the fishermen who contribute to the increased infection rate. A common practice, “fish for sex,” occurs when the 16 Avert, “The Impact of HIV & AIDS in Africa,” http://www.avert.org/aidsimpact.htm. 17 PlusNews, “South Africa: Sugar Daddies Find Plenty of Sweet Teeth,” www.plusnews.org/Report.aspx?ReportId=74910. 18 UNAIDS, “2004 Report on the Global AIDS Epidemic,” 4th Global Report, UNAIDS, http://www. unaids.org/bangkok2004/GAR2004_pdf/UNAIDSGlobalReport2004_en.pdf, 193.

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fishmongers (who are typically women) are forced to sleep with the fishermen in exchange for lower prices. If they don’t have sex for fish, they will not be able to offer competitive prices, and will be unable to stay in business. From the shores, HIV spreads outward to the surrounding areas. Many of the fishmongers that we interviewed spoke of this practice openly. While it was more difficult to get them to tell us if they participated in this activity themselves, several men corroborated the fact that the practice was widespread.

Figure 1. UNAIDS/WHO. Epidemiological Fact Sheets on HIV/AIDS and sexually transmitted infections - Kenya, 2006 update. http://apps.who.int/globalatlas/predefinedReports/EFS2006/ EFS_PDFs/EFS2006_KE.pdf (accessed July 21, 2009).

In developing countries, increasing numbers of people are being infected and are dying from AIDS not only because of a lack of medical resources, but also because of the role poverty plays in spreading HIV/AIDS. Poverty and HIV/ AIDS are interlinked and create a vicious cycle that perpetuates suffering and financial hardships. One is more likely to suffer the symptoms of AIDS during the economically most productive time of his or her life. Not only are they unable to work, but they are also unable to respond to the crisis that is affecting both themselves and their communities.19

19 UNAIDS, “The Impact of AIDS on People and Societies,” 2006 Report on the Global AIDS Epidemic, http://data.unaids.org/pub/GlobalReport/2006/2006_GR_ CH04_en.pdf.

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Figure 2. Bonnel, R. Economic Analyis of HIV/AIDS. Background Paper for the African Development Forum, September 2000 (The World Bank, Washington, D.C., 2000).

While the true ramifications of HIV/AIDS on Kenya are difficult to grasp, a useful comparison can be made to the dramatic impact that the Black Death plague had on Europe in the fourteenth century, killing about one-third of the population. In the same way, HIV/AIDS will transform Africa as we know it, for HIV/AIDS “has had and will continue to have catastrophic economic and social ramifications. Family and community well-being are being compromised, as well as development progress and national stability.”20 The Human Development Report 2003 states that “by killing and incapacitating adults in the prime of their lives, [HIV/AIDS] can throw development off course.”21 The World Bank recognizes that “if nothing is done to combat the epidemic a complete economic collapse will occur within three generations.”22 Educational Impacts The lack of education is directly correlated to a high rate of HIV risk. Although some disregard the knowledge that they have about HIV/AIDS, most have an incomplete education, if they have one at all. Education has been proven to be “a major engine of economic and social development…[and] a means to prevent HIV/ AIDS.”23 Education not only informs people about HIV/AIDS, but also opens up a forum for discussing this customarily taboo subject. We found that those who were the most educated on HIV/AIDS had been tested and had acquired their knowledge from VCT centers. Unfortunately, those most educated were usually HIV-positive and their education came too late to prevent infection. Billions of dollars of aid are being pumped into HIV/AIDS treatment. Yet, 20 UNDP 2003. 21 Ibid.. 22 Clive Bell et al., “The Long-Run Economic Costs of AIDS: Theory and an Application to South Africa,” In World Bank research report, www1.worldbank.org/hiv_aids/docs/BeDeGe_BP_total2.pdf 23 The World Bank.

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this money may be better spent on education, as education often goes further than simply addressing or preventing the virus: it also empowers those who receive it. Myths about condoms also discourage use. Several people in one village said that they did not want to use condoms because “they made their stomachs hurt.” Others claimed that there were little holes in the tip, so there was no point anyway. The overall idea that condoms just do not work prevented many from using them. There also exists the idea that condoms are the “white man’s way of preventing Africans from reproducing.” Understanding how condoms function, beyond a basic knowledge of them, would promote their use and help prevent the spread of the virus. The financial strain of HIV/AIDS often forces people to cut all extraneous expenditures, and, unfortunately, education often falls into this category. Although education in Kenya is theoretically free, parents still commonly pay “tuition” fees in order to ensure their children are able to advance to the next grade. If a parent is unable to pay tuition fees, the chance of a child progressing to secondary school is slim. When children are not educated, it is more difficult for them to get secure jobs when they are older, and they often fall prey to temporary prostitution, continuing the infectious cycle. They also lose the empowerment gained through receiving an education: “Several studies have shown that infection rates are lower among educated women. In the 1990s, HIV infection rates in Zambia fell by almost 50 percent among educated women, while there was almost no decline in those who hadn’t gone to school. In Uganda, infection rates are lower among girls who have attended high school.”24 While education has been proven to reduce one’s risk of HIV, when a family is struggling to put food on the table, learning multiplication tables seems less important. Yet, “Education is development. It creates choices and opportunities, reduces the twin burdens of poverty and disease, and gives people a stronger voice in society.”25 Because children are getting pulled out of school, they are not being educated. Parents think that they are making the economically sound choice, but in the long-run they are prolonging poverty. Unfortunately, many Kenyans do not have the luxury of thinking long-term; they are mired in the daily struggle to survive. Likewise, if people are infected with HIV, they may not have a tomorrow, so it is difficult for them to think about long-term saving. From Research to Education Program We observed that poverty coupled with a lack of education and awareness creates the perfect breeding ground for the rampant spread of HIV/AIDS especially among younger women. The conditions of extreme poverty set the stage, but it is a lack of knowledge that perpetuates this vicious cycle that engulfs so many people. In order to fully break the cycle, one needs to be empowered financially and educationally with the resources and knowledge to help prevent the spread of HIV/AIDS. This includes minimizing the financial burden of the virus by helping to manage a family’s business and savings, and learning how to support those infected with and affected by HIV/ 24 UNCDF, “Microfinance and AIDS,” http://www.uncdf.org/english/microfinance/pubs/ newsletter/ pages/dec_2003/news_hiv.php. 25 Katherine Marshall and Lucy Keough, “Mind, Heart, and Soul in the Fight Against Poverty,” World Bank, http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2004/08/27/ 000160016_20040827151448/Rendered/INDEX/298790PAPER0Mind10heart010soul.txts.

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AIDS, including taking care of the growing number of orphans. Our view of Kenya greatly shifted during our stay: we no longer see it just as a country ravaged by HIV/AIDS. Instead, we see a country that is full of life and a population that is hungry for the relevant information and tools to enable them, on their own terms, to fight back and change their lives and their communities. Specifically, the social, economic, and physical factors make change difficult, due to the great impact that HIV/AIDS is having on their daily lives. Even the CIA World Factbook26 has taken into account the effects of HIV in every piece of information they report about Kenya. Similarly, Kenyans have to constantly consider how HIV/ AIDS is presently affecting them and how it will impact their futures. Still, with all of these tremendous hardships, there is a passion and desire to live and to keep going that inspired us to continue our work in the midst of the emotionally draining stories with which we were entrusted. From the significant amount of research that we collected, we developed a comprehensive proposal for a peer education program using the “trust banks” of Opportunity International. One factor that emerged above all of the difficulties that clients were facing was their unabated desire to learn. Education is valued highly in Kenya, which is illustrated by the fact that primary school is offered for free. When we spoke to clients about a possible peer education program, more often than not they excitedly asked how soon it would be implemented, and many expressed a strong interest in being trained on how to educate their fellow trust bank members. Our program utilizes the captive audiences of trust banks to educate clients over a six-week period. Peer education has been proven to be effective across all health issues. Ideally, we would train one or two members from each group to return to their groups and educate them on HIV/AIDS, including the necessity of testing. Using the concept of peer education, there is a dispersion of empowerment that enables the program to effectively encourage measurable and sustainable behavioral change among clients. The program ensures that all clients have an adequate knowledge of the transmission and prevention of HIV/AIDS. By educating the clients, Opportunity International would effectively spread HIV/AIDS-related knowledge to families, communities, and business associates and have an impact not only on the clients of Opportunity International, but also positively improve the overall wellbeing of the community by training community leaders who are not clients. The hope is that educating entire communities will reduce the stigma associated with HIV/ AIDS by providing facilitated forums for clients to openly discuss sensitive topics related to living with and preventing the spread of HIV/AIDS. Already, programs have been taking shape and new partners are coming together to attempt to defeat this ubiquitous disease.27 Conclusion HIV/AIDS, although devastating, is manageable. There are ways to prevent and ultimately stop this disease. Promoting condom use will help slow the immediate spread of the disease. Furthering education and working to prevent HIV, as opposed 26 The World Factbook, “Kenya,” The Central Intelligence Agency, https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html. 27 U.S. Overseas Cooperative Development Council.

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to treating it, is also necessary. Making sure education programs fit the culture is the only way to ensure that a complete understanding of the disease is attained. Exposing clients and children to more education will provide them with the necessary first step to empowerment that will give them a fighting chance at breaking free from the debilitating effects of poverty and HIV/AIDS. Although HIV/AIDS can be a depressing topic, we choose to think of Mary, a woman who was infected by her recently deceased ex-husband. She has since remarried and her new partner is HIV-negative. She introduced us to the concept of living positively. This means that while she is HIV-positive, she is also living her life optimistically and not letting the disease prevent her from living her life. She started an organization with her ex-husband that feeds about 100 children a day. She also offers support to HIV-positive women in the form of hope. She encourages prayer, and believes that hope can allow an individual to survive. She brings food, when possible, on house visits and makes sure that the women are getting proper medical care. She is one of the most happy, balanced, and inspirational people we have ever met. HIV/AIDS does not have to devastate communities; it can, rather, bring them together in the fight against this seemingly impossible-to-defeat disease. Chelsea is currently a senior at Boston College, where she is working toward a Bachelor of Arts in Psychology. She can be contacted at [email protected]. Scott is also a senior at Boston College, where he is working toward a Bachelor of Arts in International Studies. He has also been accepted to Mount Sinai School of Medicine’s Humanities and Medicine program. He can be contacted at [email protected]. Works Cited Avert. “The Impact of HIV & AIDS in Africa.” http://www.avert.org/aidsimpact.htm. (accessed October 28, 2007). Bell, Clive, Shantayanan Devarajan, and Hans Gersbach. “The Long-Run Economic Costs of AIDS: Theory and an Application to South Africa,” In World Bank research report. www1.worldbank.org/hiv_aids/docs/BeDeGe_BP_total2.pdf (accessed October 28, 2007). Center for Disease Control. “Global HIV/AIDS.” http://www.cdc.gov/nchstp/od/gap/ countries/kenya.htm (accessed October 28, 2007). Encyclopædia Britannica. “AIDS.” Encyclopædia Britannica Online. http://www.britannica.com/eb/article-225030 (accessed October 28, 2007). Essex, Max, Soulymane Mboup, Phyllis J. Kanky, Richard G. Marlink, and Sheila D. Tlou. AIDS in Africa. Second Edition. New York: Kluwer Academic/Plenum Publishers, 2002. Global Monitoring Report 2008. “MDGs and the Environment - Agenda for Inclusive and Sustainable Development.” The World Bank. http://web.worldbank.org/ WBSITE/EXTERNAL/EXTDEC/EXTGLOBALMONITOR/EXTGLOMONR

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EP2008/0,,contentMDK:21709297~menuPK:4860412~pagePK:64168445~piPK:64 168309~theSitePK:4738057,00.html. (accessed October 27, 2007). International Federation of Red Cross and Red Cresent Societies. “Brave Few Challenge HIV/AIDS Stigma in Kenya.” http://www.aegis.com/news/ifrc/2001/IF010702. html (accessed October 28, 2007). Kenya AIDS Watch Institute. “Alarm Over AIDS Orphans.” http://www. kenyaaidsinstitute.org/presscolumn.html (accessed October 28, 2007). Marshall, Katherine, and Lucy Keough. “Mind, Heart, and Soul in the Fight Against Poverty.” World Bank. http://www-wds.worldbank.org/external/default/ WDSContentServer/WDSP/IB/2004/08/27/000160016_20040827151448/ Rendered/INDEX/298790PAPER0Mind10heart010soul.txt (accessed October 28, 2007). Mascolini, Mark. “Over half of HIV+ Kenyan children in dire need of antiretovirals.” International AIDS Society. http://www.iasociety.org/Default. aspx?pageId=5&elementId=10530 (accessed October 27, 2007). Mishra, Vinod, Fred Arnold, Fredrick Otieno, Anne Cross, and Rathavuth Hong. “Education and Nutritional Status of Orphans and Children of HIV-Infected Parents in Kenya.” USAID. http://pdf.dec.org/pdf_docs/PNADD 695.pdf (accessed October 27, 2007). PlusNews. “Kenya: Food Shortages Complicating ARV Programme in the North.” http://www.plusnews.org/Report.aspx?ReportId=74162 (accessed October 28, 2007). PlusNews.org. “South Africa: Sugar Daddies Find Plenty of Sweet Teeth.” www.plusnews. org/Report.aspx?ReportId=74910. (accessed October 27, 2007). UNAIDS. “2004 Report on the Global AIDS Epidemic.” 4th Global Report. UNAIDS. http://www.unaids.org/bangkok2004/GAR2004_pdf/UNAIDSGlobalReport2004_ en.pdf (accessed July 17, 2009). UNAIDS. “The Impact of AIDS on People and Societies.” 2006 Report on the Global AIDS Epidemic. http://data.unaids.org/pub/GlobalReport/2006/2006_GR_ CH04_en.pdf (accessed October 27, 2007). UNCDF. “Microfinance and AIDS.” http://www.uncdf.org/english/microfinance/pubs/ newsletter/pages/dec_2003/news_hiv.php (accessed October 28, 2007). UNDP. “Millennium Development Goals: A Compact Among Nations to End Human Poverty.” Human Development Report 2003. http://hdr.undp.org/en/reports/ global/hdr2003/ (accessed October 28, 2007).

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U.S. Overseas Cooperative Development Council. “Cooperatives Help Fight HIV/AIDS.” http://www.ocdc.coop/OCDC/hivaids.html (accessed October 27, 2007). World Bank, The. “Education and HIV/AIDS: A Window of Hope.” http:// hivaidsclearinghouse.unesco.org/ev_en.php?ID=1383_201& ID2=DO_TOPIC. (accessed October 28, 2007). World Factbook, The. “Kenya.” The Central Intelligence Agency. https://www.cia.gov/ library/publications/the-world-factbook/geos/ke.html (accessed October 27, 2007).

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PEPFAR An Historical Analysis of Mandated HIV/AIDS Funding Allocation to Abstinence Education Justin Lockwood

Abstract The gradual destigmatization of AIDS over the past half century has led to increased efforts to combat the epidemic – efforts that were absent during the disease’s emergence because of severe negative perceptions of its origins and epidemiology. During the 21st century, the demographic with the highest number of newly affected persons has shifted from homosexual men to black African women. Thus, the disease is no longer explained as punishment for “immoral” acts, as was common in the past, and the victims are no longer stigmatized for contracting it. In 2003, American president George W. Bush implemented a large-scale initiative, the President’s Emergency Plan for AIDS Relief (PEPFAR), to combat the disease worldwide by focusing billions of dollars on the fifteen countries most affected by the epidemic. Many claim that this effort will be viewed as Bush’s “finest hour.” However, the program has not gone without criticisms. A main concern that has surfaced is that the PEPFAR protocol requires large portions of the money to be used to fund abstinence-befaithful education programs. Unfortunately, the vast majority of field research has shown these types of programs are ineffective at preventing the transmission of sexually transmitted infections. As such, and in order to maximize the success of PEPFAR, substantial restructuring must occur in order to loosen spending restrictions that limit programs’ effectiveness. “Defeating HIV/AIDS once and for all will require an unprecedented investment over generations. But it is an investment that yields the best possible return: saved lives.” -President George W. Bush “[President Bush’s] decision to launch this initiative was bold, and it was unexpected. I believe historians will regard it as his single finest hour.” -Senator Joe Biden Over 25 million people have died of HIV/AIDS since its emergence in 1981. Now, there are more than 33 million people living with the disease worldwide. -UNAIDS Introduction Religion and conservative ideals have had a dampening influence on medical science throughout the duration of its development. Dating back to 1100 C.E., it has been believed that disease and religion are directly interwoven. At that time, many religious sects held that each saint could cure a specific disease, and that a

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trip to a saint’s respective shrine would be sufficient to eliminate the affliction.1 The link between the religion and the medical profession extended into the fifteenth and sixteenth centuries, when syphilis was christened a “sin of the flesh” and was purportedly the manifestation of God’s wrath, galvanized by the sinful behavior of a promiscuous society. Physicians of the time, consequently, labeled their patients as either “guilty” or “innocent” and treated them accordingly.2 Unfortunately, the “sin of the flesh” stigma did not disappear completely with the containment of syphilis or the progression of scientific knowledge. The 1981 emergence of HIV/AIDS in the United States was met with homophobia and apathy, as the disease carried with it a stigma that labeled it a punishment for sodomy. In the past half-century, this stigma has transformed, now relating to the “immoral” practice of premarital sex, and it has been used to deleteriously restrict prevention methods. Though the face of religious and conservative influence on the response to HIV/ AIDS has continuously changed in the decades since its emergence, its presence has been unyielding. Initial Stigmatization: HIV/AIDS in 1980s United States The influence of the Christian Right in the U.S. government of the 1980s produced a political environment that was unsympathetic to the homosexual lifestyle that had become prevalent in cities like San Francisco and New York City. This, coupled with the belief that AIDS was a disease permanently isolated within the gay population, led to a significant lack of funding for HIV/AIDS research: in 1984, three years and thousands of American deaths after the disease’s emergence, the National Institute of Health (NIH) allocated only 0.002% of its $4 billion budget to fund scientists and physicians who were researching the disease.3,4 This trend continued throughout the 1980s, and HIV/AIDS-related medical breakthroughs were all but absent from that period, leaving the homosexual population isolated in its attempts to survive the epidemic. The religious and conservative influence within the U.S. government also led to strict regulations on the methods used to disseminate sexual health education. Sodomy and non-marital sex were considered sins by the Catholic Church, and, thus, any attempt to make the acts safer was viewed as a sin in itself. Consequently, the Christian Right’s historical aversion to explicit discussion of sex transformed into a firm embrace of abstinence-only education. In 1994, the Catholic League, a Catholic civil rights organization, posted 2,500

1 R. Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (New York & London: W.W. Norton & Company, 1997), 83. 2 P.L. Allen, The Wages of Sin: Sex and Disease, Past and Present (Chicago and London: The University of Chicago Press, 2002), 48-50. 3 National Institutes of Health, “The NIH Almanac – Appropriations” NIH, http://www.nih.gov/ about/almanac/appropriations/index.htm. 4 Allen, 124.

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ads in New York City trains that read “Condoms Don’t Save Lives.”5,6,7 This view, however, contradicted accessible research that showed that sexual health education and subsequent condom use were effective for sexually transmitted infection (STI) prevention. For example, a public health campaign in Switzerland that endorsed condom usage among adolescents decreased the level of unprotected sex from 81% to 27%.8,9 There were, however, certain members of the Christian Right who embraced this data. In 1986, C. Everett Koop, the newly appointed Surgeon General under Ronald Reagan, released a report that strongly advocated condom use as an effective barrier to transmission and acknowledged that the virus could be spread through heterosexual intercourse.10 Likewise, the Catholic Bishops of the United States publicly supported the idea that condoms could retard the spread of the virus.11 Unfortunately, both Koop and the bishops felt pressure to retract their statements (an act which the Bishops quickly carried out) and the messages were soon forgotten. Thus, the Christian Right, along with other conservative groups, restricted and impeded attempts to combat the spread of HIV/AIDS in the United States due primarily to their opposition to explicit sexual health discussion, specifically safe sex campaigns. These beliefs arguably contributed to the deaths of tens of thousands of people. Not until the disease affected notable heterosexual Americans did public attention and support finally shift to its victims. Governmental restrictions on prevention and sexual health education, however, have been consistent since its emergence. PEPFAR: An Overview In the early 21st century, the demographic with the highest AIDS incidence changed from gay men to black women, especially throughout developing regions of Africa.12 Consequently, the disease could no longer be explained as punishment for “immoral” acts such as sodomy and intravenous drug use, and the victims now are decreasingly stigmatized for contracting it. This gradual destigmatization has led to increased efforts to combat the epidemic, meaning significantly increased federal funding for HIV/AIDS research and prevention. However, the political aversion to 5 Allen, 149. 6 Catholic League Board of Directors, “About us. Catholic League for Religious and Civil Rights,” The Catholic League, http://catholicleague.org/about.php. 7 One Catholic journal went so far as to write that “the use of condoms protects the users neither from Hell nor from AIDS” (see “Bishops to Order New AIDS Test”). 8 E. Zimmerman et al. “Changes in Switzerland: condom use in casual sex,” International Conference on Aids 7 (June 16-21, 1991): 424. 9 Allen, 126. 10 C. Everett Koop, “Health policy working group briefing: the Surgeon General’s report on AIDS” (presented in Washington, D.C., September 24, 1986). 11 United States Catholic Conference Administrative Board, “The many faces of AIDS: a gospel response,” Origins 17.28 (1986). 12 V. Montgomery-Rice, “The Healthcare Realities for Diverse Populations” (presented at the 2008 Andrew D. Hunt Endowed Lectureship, Wharton Center for Performing Arts, Michigan State University, East Lansing, MI, October 3, 2008).

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sexual health discussion and education has had a strong presence in modern medical discourse and has influenced public health prevention measures in the decades since the disease’s emergence in 1981. In 2003, President George W. Bush implemented a large-scale initiative aimed at combating HIV/AIDS worldwide. The initiative, called the President’s Emergency Plan for AIDS Relief (PEPFAR), was then reauthorized by Bush on July 30, 2008. It originally allocated $15 billion of the federal budget to fifteen focus countries for use in efforts against the disease. The focus countries, thirteen of which are in Africa, were chosen based on how severely they were affected by the disease.13 The plan allows the United States’ government to work closely with the local governments and organizations in efforts to promote prevention, treatment, and care programs for the affected populations. The U.S. Global AIDS Coordinator, currently Eric Goosby, currently heads the program. The original 2003 plan highlighted its “Five-Year Strategy,” which defined the initiative’s goals and the methods that were to be used to achieve the goals. The strategies implemented were summarized as follows:



• $10 billion for the 15 focus countries; • $4 billion for other PEPFAR countries and for additional activities including HIV/AIDS research; and • $1 billion over five years for the Global Fund to Fight AIDS, Tuberculosis, and Malaria 14,15

PEPFAR works as a public/private partnership, in which a combination of organizations and corporations receive funding with strict requirements for its use. At the beginning of every year the U.S. government announces its annual PEPFAR fiscal obligations. The funding is provided directly to a collection of Prime Partners, organizations that are under contract with the U.S. government and receive money directly. These entities then reallocate the money to various Sub-Partners. Together, the Prime Partners and the Sub-Partners are the organizations responsible for running the public health efforts in the focus countries.16 The 2008 Reauthorization allocated up to $39 billion to the global fight 13 The fifteen focus countries are Botswana, Ethiopia, Haiti, Mozambique, Nigeria, South Africa, Uganda, Zambia, Cote d’Ivoire, Guyana, Kenya, Namibia, Rwanda, Tanzania, and Vietnam. All but Haiti (central Caribbean) and Vietnam (southern Asia) are in Sub-Saharan Africa. 14 The Global Fund to Fight AIDS, Tuberculosis, and Malaria, the recipient of $1 billion under the PEPFAR budget, “is a unique global public/private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria.” It acts to attract, collect, and reallocate funds for HIV/AIDS prevention and research, acting as a sort of middle man between financial donors and programs requesting funding. Though it is not a government organization, many federal governments are highly invested in the fund by way of grants and donations. Since its creation in 2002, the Global Fund has approved roughly $11.4 billion to be used to finance 550 programs in 136 countries (see “About the Global Fund”). The U.S. has already exceeded its projected $1 billion donation (pepfar.gov). 15 U.S. Global AIDS Coordinator, “The United States President’s Emergency Plan for AIDS Relief,” PEPFAR, http://www.pepfar.gov/. 16 Ibid.

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against HIV/AIDS, the largest commitment to public health in history, as well as an additional $5 billion to fight malaria and $4 billion to fight tuberculosis.17 The program does not aim to control public health efforts in the focus countries; rather, it focuses on strengthening existing health networks by working cooperatively with national governments and domestic health professionals. To ensure that this occurs, the Office of the Global AIDS Coordinator (OGAC) emphasizes the Three Ones: “one national plan, one national coordinating authority, and one national monitoring and evaluation system.”18 This allows funding to be allocated to areas specific to the host country’s needs. Upon inception of the program, OGAC set general mandates that required that funding be allocated as follows: “55%...to HIV/AIDS treatment, 20% to HIV prevention initiatives, 15% to palliative care, and 10% to support orphans and vulnerable children.”19 Thus, a maximum of 20% of funding could be spent on prevention, which many health professionals believe to be the most crucial strategy for combating the epidemic as it is the only method of interrupting the transmission of the virus.20 Further, the OGAC required that 33% of the prevention funding be used towards abstinence-be-faithful education. These general requirements were then split into several subcategories. For instance, prevention included injection safety, condom use campaigns, blood safety, and abstinence education. Each host country has specific spending requirements based on domestic program availability, funding requests, and input from the country’s national monitoring and evaluation system.21 Overall Program Effectiveness As of March 2008, PEPFAR had affected the lives of millions. In 2007, the program worked with 2,217 organizations – 87% of which were local – and provided $601 million towards HIV/AIDS prevention in the focus countries. It is also estimated that PEPFAR facilitated the inclusion of Prevention of Mother-to-Child Transmission (PMTCT) in nearly 12 million pregnancies, a number that in itself exceeds the original goal of aiding the prevention of at least 7 million new infections by 2010.22 Thus, they were able to offer unprecedented prevention funding while still maintaining the relative autonomy of the focus countries. Even though treatment goals are yet to be fulfilled, progress has been notable. In 2003, before the program’s inception, liberal estimates placed the number of individuals receiving anti-retroviral treatment worldwide in the tens of thousands. As of March 31, 2008, 1.73 million people (1.64 million of which lived in the focus countries) had received this life-extending treatment. The program has also provided care for more than 6.6 million people affected by HIV/AIDS, including children 17 Ibid. 18 Ibid. 19 National Institutes of Health, “PEPFAR and the fight against HIV/AIDS,” The Lancet 369.9568 (2007): 1141. 20 “United Republic of Tanzania: PEPFAR Country Profile Update: Tanzania,” SIECUS (2008), http:// www.siecus.org/index.cfm?fuseaction=page.viewPage&pageID=967&nodeID=1. 21 U.S. Global AIDS Coordinator, “The United States President’s Emergency Plan for AIDS Relief,” PEPFAR, http://www.pepfar.gov/. 22 Ibid.

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orphaned by the disease.23 Despite the accomplishments of President Bush’s initiative, PEPFAR has not gone without criticism. The most pronounced opposition focuses on the required allocation of one-third of prevention funding to abstinence-be-faithful education that was part of the 2003 bill. Many argue that the fact that these goals have been met is irrelevant; the requirement causes health professionals and participating organizations to cut pertinent, necessary programs that focus on other areas of prevention including needle exchange and condom use campaigns. A review of PEPFAR carried out by the Institute of Medicine found that the most significant flaw in the implementation of the program is the aforementioned prevention-funding earmark, which negatively impacts the diversity of prevention programs.24 Similarly, a 2006 U.S. Government Accountability office report on PEPFAR spending concluded that the abstinence-be-faithful spending requirement presents significant difficulties to health professionals in the focus countries. It found that necessary programs are often cut in order that the organizations receive more funding through PEPFAR. It then recommended that OGAC reevaluate the effectiveness of the spending requirement towards fulfilling the original PEPFAR goals.25 By redistributing funding from other, more effective prevention measures to abstinencebe-faithful programs, many argue that OGAC has hindered the progress of the initiative and indirectly put lives at risk. The absence of proper funding for comprehensive sex education – sexual health education that simultaneously teaches about abstinence, condom use, STIs, etc. – is being felt throughout those countries most affected by HIV/AIDS. In Botswana, the country with the second highest HIV prevalence in the world (24%), only two of the 25 organizations receiving PEPFAR funding promote condom use.26 A study done in Madagascar in 2008 found that two of the main barriers to contraception and condom use during sexual intercourse were a lack of knowledge about the availability of contraception and misinformation about existing methods, both of which could be remedied through condom use campaigns.27 Similarly, an analysis of PEPFAR effectiveness in Zambia showed that increasing numbers of the population believe condoms do not work.28 This is of great concern, as evidence consistently shows condoms to be the most effective physical barrier against transmission through sexual

23 Ibid. 24 Jaime Sepulveda et al., eds., “PEPFAR Implementation: Progress and Promise,” The National Academies Press (2007): 113. 25 “Global Health: Spending Requirement Presents Challenges for Allocating Prevention Funding Under the President’s Emergency Plan for AIDS Relief,” U.S. Government Accountability Office (2006), http://www.gao.gov/products/GAO-06-1089T. 26 U.S. Global AIDS Coordinator, “Botswana FY 2007 Country Operational Plan,” PEPFAR (2007), http://www.pepfar.gov/documents/organization/103927.pdf. 27 Bodo Randrianasolo et al., “Barriers to the Use of Modern Contraceptives and Implications for Woman-Controlled Prevention of Sexually Transmitted Infections in Madagascar,” Journal of Biosocial Science 40 (2008): 879. 28 Gorden and Mwale, 72.

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intercourse when used correctly.29,30,31 Specifically, 17 of the 20 PEPFAR country teams claimed that the abstinencebe-faithful requirement “presents challenges to their efforts to respond to local prevention needs” because it takes away from PMTCT, medical and blood safety activities, care programs, high-risk group programs, dissemination of public health information, and condom campaigns.32 Thus, there is a growing need for comprehensive sex education that includes condom campaigns to educate affected populations on their effectiveness as barriers to HIV transmission. Abstinence-Only Education Complete abstinence is, of course, the only guaranteed way to avoid sexual transmission of HIV. Thus, it is critical for sexual health education to begin at a young age before adolescents become sexually active. Problems arise, however, when comprehensive sex education becomes abstinence-only education (AOE) and restrictions are placed on other aspects of sexual health education. Historically, AOE has proven ineffective at reversing teen pregnancy and STI transmission trends.33 To understand AOE, a consistent definition of abstinence must be offered. Though there are many, the large majority of AOE programs define abstinence using moral, rather than behavioral, terms. The goal of such programs is not simply to teach adolescents to abstain from sexual activity until marriage, but also to enforce the idea that sexuality is acceptable only within certain parameters – in this case, a faithfully committed marriage.34 Further, sexual activity can be interpreted as strictly vaginal intercourse or as any sexual behavior. Many adolescents claim to practice abstinence while engaging in oral or anal sex, both of which carry a high risk of STI transmission. AOE has been highly criticized and deemed ineffective in comparison to other sexual health education methods. A 2008 epidemiological evaluation of sexual health programs found that AOE had no effect on teen pregnancy rates, initiation of vaginal intercourse, or transmission of STIs. Further, the same study found that comprehensive sex education – which includes explicit discussion of contraception – showed no causative correlation with STI transmission or initiation of sexual activity, yet was effective at avoiding unwanted teen pregnancy.35 An additional 2008 study 29 Saifuddin Ahmed et al., “HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda,” Journal of the International AIDS Society 15.16 (2002): 2171. 30 S. Pinkerton and P. Abramson, “Effectiveness of Condoms in Preventing HIV Transmission,” Social Science and Medicine 44.9 (1997): 1310. 31 S. Weller and K. Davis, “Condom effectiveness in reducing heterosexual HIV transmission (Cochrane Review),” The Cochrane Library 4 (2003): 1. 32 “United Republic of Tanzania: PEPFAR Country Profile Update: Tanzania,” SIECUS (2008), http:// www.siecus.org/index.cfm?fuseaction=page.viewPage&pageID=967&nodeID=1. 33 Pamela Kohler et al., “Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy,” Journal of Adolescent Health 42 (2007): 344. 34 John Santelli et al., “Abstinence-only education policies and programs: A position paper of the Society of Adolescent Medicine,” Journal of Adolescent Health 38 (2006): 83. 35 Kohler et al., 344.

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corroborated these results, finding no evidence that comprehensive sex education can lead to increased rates of STI transmission or engagement in sexual intercourse.36 Thus, the popular fear that explicit discussion of sex promotes sexual activity is unwarranted. AOE programs are more ineffective in Sub-Saharan Africa – the focus of the majority of PEPFAR funding – than in the United States because societal norms and trends are notably different. Much of the adolescent sex occurring in PEPFAR countries is within marriage, though often premature and as a result of coercion or bribery.37 Thus, AOE programs must be remodeled in a way that separates the idea of abstinence from that of committed marriage, and should take local considerations into account. In the 1980s, President Museveni of Uganda began a national effort against HIV/AIDS that focused on what he called the ABCs of sexual health education: Abstinence, Be faithful, and Condoms. His program has shown great success, with the rates of initiation of vaginal sex and HIV transmission steadily decreasing since 1992.38 Museveni’s original program used abstinence education as one of many tools to decrease the rate of HIV transmission within Uganda. The United States’ government initially used the ABC program as a model for the development of PEPFAR. By the time of its inception, however, the program had parted significantly from its Ugandan precursor. This separation occurred primarily because the three facets of Museveni’s program were not given equal weight in the United States’ version: abstinence education was disproportionately supported in comparison to condom use campaigns, and, as a result, the comprehensive sex education framework was lost. Proponents of U.S.-based AOE programs focus on the morality of sexual activity rather than the epidemiological statistics. One organization that receives PEPFAR funding in South Africa stated that its main goal is to “introduce young people to Jesus” and to establish a “commitment to Jesus and also to abstinence, whichever comes first.”39 Thus, many oppose sexual activity before marriage because they believe it is an immoral act, not because they believe that it will reduce the rates of STI transmission and unwanted pregnancy. However, the main problem is not that the majority of African organizations choose to focus on AOE, but rather that the PEPFAR requirements force them to adopt AOE strategies. Though PEPFAR does not only implement strict abstinence-only education, it does require that funding be used for abstinence-be-faithful campaigns to the exclusion of other prevention methods. This then forces organizations to replace their typical programs, especially condom use campaigns, with abstinence-be-faithful campaigns in order to fulfill the guidelines to receive funding. Consequently, the majority of prevention money is allocated to abstinence-be-faithful programs, a measure that contradicts the findings of a majority of epidemiological studies 36 Clarissa Kripke, “Abstinence-Plus Programs for Prevention of HIV,” American Family Physician 77.7 (2008): 955. 37 Robert Blum, “Uganda AIDS Prevention: A,B,C and Politics,” Journal of Adolescent Health 34 (2006): 429. 38 Ibid., 431. 39 “Scripture Union of South Africa,” Vision, (2008), http://www.su.org.za/vision.htm.

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showing the strategy to be ineffective. Thus, the abstinence-be-faithful strategy supported by the United States’ government is, in effect, an AOE strategy, as it indirectly cuts funding from non-abstinence campaigns, leaving only those that fit the government’s mold. By excluding the “condoms” aspects of Museveni’s ABCs of sexual health, PEPFAR loses a necessary aspect of HIV/AIDS prevention. None of Museveni’s three strategies are sufficient when one is absent. The American Society for Adolescent Medicine stated their position on AOE in PEPFAR as follows: Current U.S. federal law and guidelines regarding abstinence-only funding are ethically flawed and interfere with fundamental human rights… Current funding for abstinence-only programs should be replaced with funding for programs that offer comprehensive, medically accurate sexuality education.40 Until this is done, the maximum decrease in HIV/AIDS prevalence in focus countries is unlikely to be achieved. Conclusion The 2008 PEPFAR Reauthorization did not include the explicit prevention allocation requirement for AOE. However, “The new requirement states that if funding in this area falls below 50 percent of the total allocation for prevention of sexual transmission of HIV in any country, the Office of the Global AIDS Coordinator…must issue a report to congress to explain the failure to prioritize abstinence and marriage promotion.”41 Thus, OGAC has responded to the criticisms of the original 2003 program by masking the problem, rather than fixing it. The abstinence-be-faithful portion of the prevention methods has not disappeared, but has been restructured and renamed in an effort to hide its presence. Research has consistently shown AOE to be ineffective, yet OGAC and the United States’ Congress maintain their attachment to it. Consequently, funding is removed from other areas of prevention, leading to increased dissemination of misinformation throughout the affected populations and a lack of proper education regarding HIV/AIDS transmission. Comprehensive sex education has repeatedly been proven to decrease rates of STI transmission and initiation of sexual activity, yet it is seeing decreases in financial aid due to PEPFAR’s funding requirement. Removing the abstinence-be-faithful funding requirements will allow the PEPFAR Prime Partners and Sub-Partners to individually analyze their target populations and, using legitimate epidemiological evidence and techniques, implement the most appropriate combination of sexual health strategies. With the current requirement in place, however, PEPFAR funding of comprehensive sex education will not occur. Though secularism has become more pronounced in the current United States’ government than it was in the 1980s during the emergence of HIV/AIDS, the Christian Right still maintains a strong influence in political discourse. The historical 40 Santelli et al., 86. 41 “United Republic of Tanzania: PEPFAR Country Profile Update: Tanzania,” http://www.siecus.org/ index.cfm?fuseaction=page.viewPage&pageID=967&nodeID=1.

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governmental attachment to abstinence-only education revolves around the moral belief that sexual activity before marriage is sinful rather than focusing on the epidemiological effects of the prevention measures. Until this is reversed and the actual prevalence of HIV/AIDS takes priority over moral values, the spread of the disease cannot be maximally contained. Justin is currently a first-year graduate student at Michigan State University’s College of Human Medicine. He can be contacted at [email protected]. Works Cited About the Global Fund. “Investing in Our Future: The Global Fund to Fight AIDS, Tuberculosis, and Malaria.” The Global Fund (29 November 2008). http://www. theglobalfund.org/en/site/?lang=en. Ahmed, Saifuddin, Tom Lutalo, Maria Wawer, David Serwadda, Nelson K. Sewankambo, Red Nalugoda, Fred Makumbi, Fred Wabwire-Mangen, Noah Kiwanuka, Godfrey Kigozi, Mohamed Kiddugavu, and Ron Gray. “HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda.” Journal of the International AIDS Society 15.16 (2002): 2171. Allen, P.L. The Wages of Sin: Sex and Disease, Past and Present. Chicago and London: The University of Chicago Press, 2002. “Bishops to order new AIDS test.” Human Life International Reports (1988): 6-8. Cited in Allen, P.L. The Wages of Sin: Sex and Disease, Past and Present (Chicago and London: The University of Chicago Press, 2002), 141. Blum, Robert. “Uganda AIDS Prevention: A,B,C and Politics.” Journal of Adolescent Health 34 (2006): 429, 431. Catholic League Board of Directors. “About us. Catholic League for Religious and Civil Rights.” The Catholic League. http://catholicleague.org/about.php. “Global Health: Spending Requirement Presents Challenges for Allocating Prevention Funding Under the President’s Emergency Plan for AIDS Relief.” U.S. Government Accountability Office (2006). http://www.gao.gov/products/GAO06-1089T. Gorden, Gill, and Vincent Mwale. “Preventing HIV with young people: A case study from Zambia.” Reproductive Health Matters 14.28 (2006): 72. Kohler, Pamela, Lisa E. Manhart, and William E. Lafferty. “Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy.” Journal of Adolescent Health 42 (2007): 344.

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Koop, C. Everett. “Health policy working group briefing: the Surgeon General’s report on AIDS.” Presented in Washington, D.C., September 24, 1986. Kripke, Clarissa. “Abstinence-Plus Programs for Prevention of HIV.” American Family Physician 77.7 (2008): 955. Montgomery-Rice, V. “The Healthcare Realities for Diverse Populations.” Presented at the 2008 Andrew D. Hunt Endowed Lectureship, Wharton Center for Performing Arts, Michigan State University, East Lansing, MI, October 3, 2008. National Institutes of Health. “PEPFAR and the fight against HIV/AIDS.” The Lancet 369.9568 (2007): 1141. National Institutes of Health. “The NIH Almanac – Appropriations.” NIH. http:// www.nih.gov/about/almanac/appropriations/index.htm. Pinkerton, S. and P. Abramson. “Effectiveness of Condoms in Preventing HIV Transmission.” Social Science and Medicine 44.9 (1997): 1310. Porter, R. The Greatest Benefit to Mankind: A Medical History of Humanity. New York & London: W.W. Norton & Company, 1997. Randrianasolo, Bodo, Teresa Swezey, Kathleen Van Damme, Maria R. Khan, Noro Ravelomanana, NY Lovanianina Rabenja, Mbolatiana Raharinivo, April J. Bell, Denise Jamesona4, The MAD STI Prevention Group, and Frieda Behets. “Barriers to the Use of Modern Contraceptives and Implications for WomanControlled Prevention of Sexually Transmitted Infections in Madagascar.” Journal of Biosocial Science 40 (2008): 879-893. Santelli, John, Mary A. Ott, Maureen Lyon, Jennifer Rogers, and Daniel Summers.. “Abstinence-only education policies and programs: A position paper of the Society of Adolescent Medicine.” Journal of Adolescent Health 38 (2006):83-87. “Scripture Union of South Africa.” Vision (2008). http://www.su.org.za/vision.htm. Sepulveda, Jaime, Charles Carpenter, James Curran, William Holzemer, Helen Smits, Kimberly Scott, and Michele Orza, eds. “PEPFAR Implementation: Progress and Promise.” The National Academies Press (2007): 113. “United Republic of Tanzania: PEPFAR Country Profile Update: Tanzania.” SIECUS (2008). http://www.siecus.org/index.cfm?fuseaction=page. viewPage&pageID=967&nodeID=1. United States Catholic Conference Administrative Board. “The many faces of AIDS: a gospel response.” Origins 17.28 (1986). Cited in Allen, P.L. The Wages of Sin: Sex and Disease, Past and Present (Chicago and London: The University of Chicago Press, 2002), 140.

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U.S. Global AIDS Coordinator. “Botswana FY 2007 Country Operational Plan.” PEPFAR (2007). http://www.pepfar.gov/documents/organization/103927.pdf. U.S. Global AIDS Coordinator. “The United States President’s Emergency Plan for AIDS Relief.” PEPFAR. http://www.pepfar.gov/. Weller, S., and K. Davis. “Condom effectiveness in reducing heterosexual HIV transmission (Cochrane Review).” The Cochrane Library 4 (2003): 1. Zimmerman, E., D. Hausser, F. Dubois-Arber, and P. Zeugin. “Changes in Switzerland: condom use in casual sex.” International Conference on Aids 7 (June 16-21, 1991): 424.

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The Tarnished Pearls of Africa A Comparative Historical Analysis of Pre-colonial, Colonial, and Post-colonial States in Africa Katie Omstead

Abstract African societies have been utterly transformed, often not for the better, as a result of their historical encounters with the west. Indeed, numerous states that were glorified as the treasures of Africa during colonial rule and just after independence have, for the most part, failed to develop into peaceful, sustainable societies. A condition of underdevelopment, instability, and deprivation exists that has prompted theoretical debate surrounding root causes. Often ignored or downplayed in theoretical justifications, the one common crosscutting factor relevant to the current state of affairs in Africa is colonization. Drastic direct and indirect political, societal, and economic changes occurred throughout Africa in a relatively short period of time as a result of colonization. Today, even the most coveted nations of colonial Africa have largely failed to prosper. A comparison of Uganda, the Democratic Republic of the Congo (DRC), and Kenya assists in more thoroughly comprehending the historical changes that have occurred, and highlights the glaring differences between the pre-colonial and post-colonial prospects for Africa. Introduction There exists a glaring difference between pre-colonial and post-colonial African societies. Numerous states that were glorified as the treasures of Africa during colonial rule and just after independence have, for the most part, failed to develop into peaceful, sustainable societies. A comparison of pre-colonial, colonial, and post-colonial Uganda, the Democratic Republic of the Congo (DRC), and Kenya assists in a more thorough understanding of the current realities for many African countries. These three African countries now suffer from bouts of political instability, social upheaval, and economic failure. Although their pre-colonial identities and post-colonial experiences somewhat differ, each of the above countries share similar colonial pasts, including imposed colonial leadership, the presence of a domineering European population, repression of the native peoples, and the implementation of an under-prepared government upon independence. Overall, these countries share the experience of drastic direct and indirect political, societal, and economic changes that occurred in a relatively short period of time as a result of colonization. One problem in much of the literature surrounding the devastation of modernday Africa is a lack of recognition of the enduring impact of colonization. The link between the implemented colonial state and the post-colonial state that gradually surfaced from the existing foundations has often been disregarded in the study of African politics.1 For example, the arbitrary borders drawn by colonial rulers have never been thoroughly challenged, even though they brought numerous ethnic groups together within one nation that neither reflected nor accommodated such ethnic and

1 Rob Dixon, “The Colonisation of Political Consciousness: States and Civil Society in Africa,” in Africa in Crisis, ed. Tunde Zack-Williams, Diane Frost, and Alex Thomson (London: Pluto Press, 2002), 62, 68.

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cultural diversity.2 Lacking criticism of the root causes of the present problems has further complicated the task of countering the complex and stark realities in many African states. Disregard and Disrespect of Pre-Colonial Territories The European colonization of Africa effectively altered almost every aspect of society. The nineteenth century began amidst the bustling slave trade and blank continental maps, and ended with the slave trade’s abolishment and the exploration of almost every inch of the continent by Europeans. Africanist Crawford Young calls the Africa of the late nineteenth century “a ripe melon awaiting carving,”3 in which the colonial powers scrambled to claim the best land. This was decided at the 1884-1885 Berlin Conference, during which would-be colonizers drew up the rules of territorial possession, trading spheres of influence “like prizes in some great game of monopoly.”4 In a short period of time, European powers accumulated over one-fifth of the total globe as a colonial possession; thus, it is not surprising that the colonial powers failed to implement ideal systems accountable or beneficiary to the African reality. In Uganda, colonization had an immediate and drastic effect, as it altered the traditional layout of the country.5 Before the arrival of Europeans, Uganda was not a nation-state, but rather housed several kingdoms. From the beginning, there was resistance to colonization throughout the kingdoms. For example, the king of Bunyoro-Kitara fought imperialism in the late 1800s, but the kingdom was overcome by armed violence in 1899 and its king was deported.6 Due to similar circumstances, the kings of both Buganda and Bunyoro-Kitara were deported and died in exile. Thus, the strongest forms of traditional authority were quickly eliminated in order to create a society beneficial to the British. Undoubtedly, one of the most devastating examples of colonization in Africa is that of the DRC. Similar to Uganda, the DRC had several significant pre-colonial kingdoms, which included the Kongo Kingdom, the Kuba Kingdom, the Luba Kingdom, and the Lunda Kingdom. These kingdoms had well-established trade patterns outside of Africa well before European exploration and colonization. During the fifteenth and sixteenth centuries, the Kongo Kingdom flourished and established ties with Portugal. However, by the late nineteenth century, Belgium’s King Leopold had consolidated personal control over the DRC by applying Stanley’s treaties. Acting as a representative of King Leopold, the explorer Henry M. Stanley acquired the DRC by signing more than 450 treaties with indigenous chiefs. Consequently, the DRC became Leopold’s private African kingdom, until it became an official Belgian 2 Anup Shah, Global Issues, December 30, 2006, http://www.globalissues.org/. 3 Crawford Young, “The Heritage of Colonialism,” in Africa in World Politics, The African State System in Flux, ed. John W. Harbeson and Donald Rothchild (Oxford: Westview Press, 2000), 23. 4 Robert F. Stock, Africa South of the Sahara: A Geographical Interpretation, 2nd edition (Guilford Press: New York, 2004), 118. 5 Thomas P. Ofcansky, Uganda, Tarnished Pearl of Africa (Boulder, CO: Westview Press, 1996), 13. 6 M. Semakula Kiwanuka, “Colonial Policies and Administrations in Africa: The Myths of the Contrasts,” African Historical Studies 3.2 (1970): 296-97.

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colony in 1906.7 During Leopold’s rule, he applied outright exploitation, including horrendous methods of extracting ivory and rubber, which led to much devastation and the death of many indigenous inhabitants. Another area of Africa drastically altered during colonization was Kenya. The colonization of Kenya actually stemmed from a European desire to have a more direct route to Uganda. In 1883, Joseph Thomson, a Scottish explorer, entered Masai country and the Kenya highlands in an attempt to discover an alternate way to Uganda. Soon after, many others followed, and in 1895, the British East Africa Protectorate was proclaimed. A year later, the construction of railways permanently connected the African hinterland to new ways of life.8 This forever altered the political, social, and economic conditions throughout the Protectorate, which in time was renamed Kenya. The pre-colonial environment in Kenya differed from the kingdoms throughout Uganda and the DRC. Kenya’s pre-colonial past included economically linked small-scale societies, mainly made up of pastoral groups.9 Caravans of Swahili and Arab traders stimulated minor political and economic changes in the 1800s, but at the start of the twentieth century Nairobi remained a shantytown.10 In 1901, the East Africa Land Acquisition Order in Council “authorized the commissioner to sell, grant, lease, or otherwise dispose of land” in Kenya. Between 1900 and 1910, white settlers applied force and seized more than six million acres of land for use as pastures known as the “White Highlands.”11 This had a grave impact on the local population, who had traditionally shared land communally. The new settlers, unwilling to relinquish any rights to the fertile land, ignored the idiom, “violence breeds violence.”12 This age-old understanding would in time prove itself true in Kenya and elsewhere throughout Africa. The Rapid and Thorough Colonization of Africa In a very short period of time, Africa was transformed. Seemingly overnight, the people of Africa had lost their independence, identity, and power. Even though colonization only lasted for seventy years – a relatively short period in the “context of universal historical development” – it occurred at a very fast rate, and included the suppression of traditional power structures, which drastically altered the functions of existing societies.13 Colonialism altered the “historical political geography of Africa in a few years’ time,”14 and its intensity still casts a shadow upon the continent. Accordingly, colonialism rapidly transformed numerous aspects of pre-colonial Africa. The political, economic, and social institutions put in place during colonization 7 Wayne Edge, Africa, 11th edition (Dubuque, Iowa: McGraw-Hill, 2006), 23, 32, 34. 8 George Bennett, Kenya, A Political History, The Colonial Period (London: Oxford UP, 1963), 1, 4. 9 Edge, 70. 10 Ibid.; Bennett, 5. 11 Edge, 9, 70. 12 Bennett, 22. 13 Walter Rodney, “How Europe Underdeveloped Africa,” in Borders, Thinking Critically About Global Issues, ed. Paula S. Rothenberg (New York: Worth Publishers, 2006), 115-116. 14 Young, 24.

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have remained seemingly impervious to amendment. The claim that the state was the best form of political community for Africa was instituted by privileged, western elites heavily influenced by the notion of civilization in Europe. Consequently, the majority of modern African states “are products of the competitive subordination of Africa...by seven European nations: Belgium, France, Germany, Great Britain, Italy, Portugal, and Spain.”15 The concept of the nation-state that was forced upon Africa has remained, even though at the time of its creation it gave Africans little or no say over their own affairs. Today, the colonial framework of “arbitrarily constructed territorial units,”16 drawn without clear nationhood or political unity, make up the basis of political life in Africa. The European powers scrambled to claim the best areas for both settlement and resource exploitation, and from the beginning Uganda was deemed the ideal African state. John Hannington Speke, one of the first explorers of Uganda, called it “the pearl of Africa,” as it was coveted for its location and its climate, as well as for containing the source of the Nile River at Bujagali Falls. After the arrival of European businessmen, explorers, and missionaries, Great Britain issued the 1884 Declaration of a Protectorate over Buganda. Next, an Anglo-German agreement, signed on July 1, 1890, ended a conflict over the land and marked the start of British colonization. On December 26, 1890, a treaty between Britain and the Buganda Kingdom made Britain responsible for the maintenance of internal order.17 Soon after, the Uganda Treaty of 1900 implemented indigenous self-rule in the Buganda Kingdom, which led to ethnic tensions in the country.18 This was due to unequal wealth and education benefits given to the Bugandan ruling class.19 In June 1914, the Union Jack was raised in modern-day Kampala, and Uganda became a Protectorate of Britain.20 This united the southern highlands and the plains of the northeast; yet, “the zones developed separately under colonial rule.”21 Thus, Britain applied a form of federalism to maintain absolute power over the ethnically diverse Ugandan people, which intensified existing tensions. In the DRC, Leopold’s main goal was not to govern the people, but to exploit the area for resources. Leopold’s reign of terror stripped the DRC of much of its resources heavily valued at the time, as there were high European demands for rubber and ivory.22 Leopold claimed that everything in his new territory – both people and resources – were his personal property. In order to secure these resources, limitations were placed upon native rights, such as a decree that restricted natives solely to the area around villages and towns, while the remaining land became de facto state

15 Ibid., 23. 16 Dixon, 61. 17 Ofcansky, 13, 19. 18 Edgar F. Almeida, “Was the Colonial Policy of Ethnic Self-Rule Responsible for the Divided Polity in Uganda?” (MA thesis, University of Western Ontario, 2000), 1. 19 Edge, 100. 20 Bennett, 3. 21 Edge, 100. 22 Jerry Kloby, “The Legacy of Colonialism,” in Beyond Borders, Thinking Critically About Global Issues, ed. Paula S. Rothenberg (New York: Worth Publishers, 2006), 100.

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property.23 The atrocities committed for the harvest of rubber by Belgian soldiers and a native army were kept largely hidden from Europe. After just two decades of Leopold’s rule, it is estimated that “ten million inhabitants of the Congo died either directly at the hands of soldiers, from starvation, or from disease brought about by colonial exploitation.”24 In total, more than half of the population perished from the hardships of colonial subjugation.25 Accordingly, Leopold’s rule not only altered the political and economic circumstances within the DRC, but also directly engendered a genocidal massacre. Once the DRC came under the official rule of Belgium, rather than the personal rule of Leopold, the violent processes subsided. Belgian rule from 1906 to 1960 was less brutal, but the tradition of mistreatment continued, as the Belgians, similar to other colonial rulers, introduced unfair institutions to benefit the Belgian settlers.26 The DRC was heavily controlled by outside forces, including the Catholic Church, the Belgian government, and western business.27 Little power was given to the local population and Belgium came to be a paternalistic leader, which accounted for the DRC’s low level of preparedness at independence. Throughout many African colonies, systems were created in favour of the white minority population, which economically benefited the colonizers. A major problem was the development of policies created in Europe that did not reflect African needs, as the development of modern, self-reliant nation-states was never a goal. The introduction of economic practices set up to benefit Europe, alongside the breakdown of indigenous social relationships, account for some of the present developmental problems. René Dumont, a French economist, warned in the mid1960s that there was a “false start in Africa” in terms of agricultural production; yet, warnings such as these were widely ignored.28 Critical analyses of the colonial processes in Africa came too late. The colonizers not only influenced the political and economic spheres, but also many other areas of society. The linguistic and cultural impact was all-encompassing, specifically in Sub-Saharan Africa. Similarly, political consciousness was easily colonized due to “the educative, socializing, and hegemonic function of colonial civil society.”29 This had a significant influence in community and state development, because it marginalized all non-state visions of the political community. Colonialism reached much farther than trade, as the social institutions put in place halted “indigenous cultural goals” and as a result altered the social identity of youth.30 Likewise, the colonial powers recognized the opportunity to stimulate tribal jealousies 23 Edge, 32. 24 Ibid., 101. 25 Stock, 121. 26 Edge, 32. 27 Kiwanuka, 309. 28 Tunde Zack-Williams, “Introduction: Africa at the Millennium,” in African in Crisis, ed. Tunde ZackWilliams, Diane Frost, and Alex Thomson (London: Pluto Press, 2002), 2. 29 Dixon, 71. 30 Rodney, 116.

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in order to divert the colonized peoples from revolt. The colonial powers destroyed unity and traditional practices indirectly through implemented western practices, and directly constructed tensions that served to preserve colonial power and continue resource exploitation. The Uneven Road to Independence With time, both the colonizers and the colonized realized the shortcomings of the colonial systems. Across Africa, responses to colonial rule came in the form of both passive and active resistance. There were numerous forms of subtle, yet protracted, resistance that may not have heavily affected the onset of independence, but may have nonetheless added to the tensions felt by colonial administrators on the ground. An example is Kenya’s Mau Mau guerilla resistance, which began in 1951 with attacks on white settlers.31 The economic and political trends that Britain had introduced to Kenya, along with the concept of nationalism, gave birth to this challenge to British rule.32 Even though the Mau Mau was largely destroyed, it did succeed in threatening stability in a state controlled by Britain, one of the most powerful countries in the world. In Africa, the end of colonial rule was ushered out with the most dominant, often European-backed, personality in each state becoming the nation’s default founding father. Africans did not have an effective voice in the process, and as a result, colonial powers quickly handpicked the leaders they believed would not pose a challenge to European wishes. Thus, many of the African rulers who replaced the colonial leaders were heavily influenced by outside objectives. Independence spread quickly across the continent. In the 1960s, most of the African continent was liberated from colonial rule, with many of the independence days occurring in 1960, which became known as the great uhuru, or freedom year.33 During this decade of immense transition, 31 countries became independent.34 At the time, the most ambitious goals appeared attainable, as even “[n]on-Africans spoke of the resource-rich continent...on the verge of a development takeoff.”35 Following the high hopes of the early 1960s, difficulties in Africa mounted. By the 1970s, the period of optimism had faded. For the majority of Africans, independence led to a fight for survival, in the guise of an exciting road to development.36 Across the continent independence was met with a steady decline in per capita food production, while services in health care, education, and transportation faltered.37 Many of the most trying struggles, including bankruptcy, state collapse, civil war, and widespread famine, 31 Edge, 70. 32 Pal Ahluwalia and Charmaine McEachern, “Founding Father Presidencies: The Case of Kenya and South Africa,” in The Post-Colonial Condition, Contemporary Politics in Africa, ed. D. Pal Ahluwalia and Paul Nursey-Bray (Commack, NY: Nova Science Publishers, 1997), 83. 33 Edge, 2. 34 Stock, 3. 35 Edge, 2. 36 Ibid. 37 Russ Hoyle, “A Continent Gone Wrong,” Time Magazine, January 16, 1984, 26.

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have persisted to the present day. In 1962, Uganda became an independent state. The first post-colonial instrument, Uganda’s Constitution, was created through negotiations between the new nationalist politicians and the departing colonial power.38 The constitution made Uganda “a federation of four regions based broadly on the traditional kingdoms.”39 It contained many faulty provisions, including its recognition of “opportunistic alliances” and its promotion of Buganda’s aristocracy – who were disliked by the majority – as the superiors of Uganda.40 The constitution provided the north with military control and the south with political control. This privileged the Bugandans in the south in terms of economic and political power, which exacerbated tensions with the military forces in the north. These tensions led to the manifestation of ethnic grievances, supported through political parties and the army, as the people’s energy was misdirected to ethnic politics in which the oppressed were positioned in opposition.41 The advantageous place of Buganda within the politics of Uganda has been a controversial issue from independence to the modern day.42 The political and military divisions of power intensified numerous problems in Uganda. The separation “of power between [the] two sharply polarized centers of authority” is still largely cited as the root cause of Uganda’s instability.43 At independence, the colonial powers also left blurred lines “between the rights of the states and the power and authority of the central government,”44 which perpetuated a variety of struggles and conflicts over matters such as land and economic distribution. Similarly, the division of powers between the executive Prime Minister and ceremonial President was unclear and therefore laden with potential conflict. Accordingly, in 1962, Ugandans were left with an unstable and divided government, military, and people. Problems followed immediately. During the Buganda Crisis of 1964, the Ugandan army attempted to kill the king of Buganda. The first in a series of events in which the state would turn its guns on its own people, this event led to the creation of Uganda’s 1967 Constitution. Implemented by President Obote, it abolished all traditional kingdoms and created a one-party state, which became repressive.45 At its best, the new constitution was a hasty instrument used to consolidate personal power, and at its worst, a completely ignored document. 46 Like many of the African constitutions put into place soon after independence, it did little to fix any of the problems Uganda faced. Like many other African states, the DRC achieved independence during the freedom year of 1960, under Prime Minister Lumumba and President Kasavuba. 38 J. Oloka-Onyango, “Constitutional Transition in Museveni’s Uganda: New Horizons or Another False Start?” Journal of African Law 39.2 (1995): 157. 39 Stock, 442. 40 Oloka-Onyango, 158. 41 Almeida, 1, 3. 42 Oloka-Onyango, 163. 43 Almeida, 1. 44 Oloka-Onyango, 158. 45 Stock, 442. 46 Oloka-Onyango, 159.

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A federal system was established at a constitution conference in 1960, yet no actual preparation existed for extensive political change. This led to the almost immediate eruption of political chaos. One week following independence, an army mutiny caused widespread disorder. This was the first event of the Congo crisis, during which hatred for the former colonial masters quickly turned to violence and caused the majority of Europeans to flee.47 The DRC was thus left in isolation, as a newly independent state. Many of the necessary preconditions for peace and stability were missing at the time of independence within the DRC. Similar chaos across Africa made it apparent that there existed a crucial link between some form of higher education or leadership experience, and peaceful transitions of political power.48 Unfortunately, in 1960, only 16 Congolese held university degrees, and most traditional forms of leadership had been destroyed.49 The Congo crisis following independence accentuated and highlighted this vital connection. The crisis quickly became symbolic of Africa’s incapacity for successful independence, with “evidence that chaos and corruption would be the hallmark of independent states.”50 Britain had recently lost control of Uganda, and by 1963 it had become apparent that the current political, economic, and social conditions within Kenya could not endure. The colony, dominated by white settlers, was politically and militarily untenable. Thus, Kenya was granted independence after nearly seventy-five years of British rule. Jomo Kenyatta emerged as “the charismatic leader of Kenya’s nationalist movement,” as well as the leader of “the Pan-African movement.”51 Kenya seemed better situated than Uganda and the DRC for independence, but was still unprepared. Post-Colonial Difficulties The newly formed independent governments of Uganda, the DRC, and Kenya had difficulty maintaining European-style political systems and securing the needs of their citizens. In addition, many African leaders copied the worst forms of greed, elitism, and mismanagement “bequeathed to them by the colonial powers.”52 The instability in Uganda, the DRC, and Kenya has been partially attributed to the lack of national unity, due to ethnically divided citizens, which encouraged the formation of autocratic, sub-national governments. Traditional chiefs were once again recognized, but became the puppets of outside domination.53 The move to authoritarian and single-party states was due, in part, to the newly independent governments’ inability to function. Following decolonization, nearly every African state experienced problems pertaining to government authority, state legitimacy, and the provision of basic economic, political, and social needs. 47 Edge, 32. 48 Kiwanuka, 309. 49 Edge, 32. 50 Stock, 136. 51 Bennett, 161; Edge, 70. 52 Hoyle, 4. 53 Edge, 7, 2.

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Many new governments failed to maintain perhaps the most positive portion of their colonial inheritance: “the infrastructure of roads, railways, cities, and towns built by Europeans.”54 For example, the DRC had 58,000 miles of usable roads at independence; now, less than 2,000 miles of travelable roads exist.55 Thus, many African regimes, faced with rising expectations and few resources, looked to alternative systems for help. Numerous inherited democratic structures of colonialism were replaced with centralized, one-party states.56 The civil service, the military, and trade unions all became closely controlled, as decisions came to rest with the few.57 These police states, in which opposition was curtailed and security measures were established to control indigenous populations, encouraged military coups.58 An absence of political opposition gave the military an excuse to intervene and overthrow ineffective governments.59 The national consciousness present at independence was swiftly replaced with clientelism and corruption.60 The combination of one-party states, ineffective governments, and clientelism helped to set the stage for constitutional and political instability. To this day, several African states are controlled by corrupt elites running ineffectual institutions.61 Since independence, many African states have struggled to maintain political stability. In a study by Ladun Anise – which followed regime changes and successions in forty African countries from independence to 1972 – it was found that few transfers upheld constitutional procedures; rather, the majority were the result of assassinations and coups.62 Likewise, between 1960 and 2002, 85 coups occurred in 35 African states.63 These coups created unrest and uprisings, which sowed the seeds for additional coups. Similar to other African experiences, the post-independence leaders of Uganda came to power through coups. Carried by the high hopes of the people, the leaders quickly came to be loved, feared, and hated. Under the dictatorships of Milton Obote and Idi Amin, hundreds of thousands of Ugandans were killed at the hands of the state. Amin, who ousted the original independence leader Obote in a 1971 military coup, is considered to be one of the most heinous leaders in history. He favoured the Kakwa and Muslims, expelled 400,000 Asians, targeted the majority Christian population, and attacked those who he considered to be educated. To this day, exact

54 Hoyle, 1. 55 Ibid. 56 Zack-Williams, 2-3. 57 Stock, 136. 58 Edge, 7. 59 Stock, 137. 60 Zack-Williams, 2. 61 Dixon, 63. 62 Pal Ahluwalia, “Postcolonial Dilemmas: Political Succession in Kenya,” in The Post-Colonial Condition, Contemporary Politics in Africa, ed. D. Pal Ahluwalia and Paul Nursey-Bray (Commack, NY: Nova Science Publishers, 1997), 10. 63 Stock, 137.

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death counts are unknown, but estimates range from 500,000 to one million deaths.64 The current leader, Yoweri Museveni, has been hailed by many as the ideal, modern African leader, regardless of his refusal to restore a system of multiparty democracy. Noteworthy progress has been made under Museveni’s direction and much of Uganda, excluding the North, has improved from the decay and chaos that prevailed throughout the 1970s and 1980s.65 The North, however, remains in a perilous state of underdevelopment and instability, due to an ongoing conflict between the government and the Lord’s Resistance Army, an armed group infamous for grievous human rights violations, including the use of child soldiers. In both Uganda and the DRC, some of the worst forms of human rights violations and civil war have taken place. In the DRC, the civil war of the 1990s produced millions of refugees, severely undermined the efficacy of the central government, and resulted in the overthrow of Mobutu Sese Seko. The constant instability and suffering in the DRC has made it an exemplary state failure. The search for democracy and responsible leaders has been a constant struggle. Many leaders, such as Laurent-Désiré Kabila, who came to power as a result of rebellion in 1997, have achieved neither competent governance nor peace. In 2001, Kabila was assassinated and his son, Joesph Kabila, took power unconstitutionally.66 In 2006, he was elected as the DRC’s first Congolese president ushered in by universal suffrage, which is a positive step. Until recently, Kenya has experienced a rather calm, yet heavily controlled, post-colonial independence. Under Kenyatta, the future looked promising with the encouragement of racial harmony, land reform, business opportunities, and African socialism. By 1966, however, Kenya was a one-party state and remained so until 1991.67 Kenyatta ruled until 1978, during which time he became increasingly autocratic and intolerant of opposition. His Vice-President, Arap Moi, assumed power until 2002, and was heavily criticized for the use of suppression and corruption.68 Moi, who was very resistant to “good governance,” added to the trend of corruption within the Kenyan government.69 It still remains to be seen whether the current President Mwai Kibaki will keep his promises of responsible and fair governance, or if he will instead follow in the footsteps of decades of corruption and unaccountability. Present Day and the Challenges of the Future Today, the situation in many African states remains complex. Independence may have come, but it has not been accompanied by promised advantages.70 A pattern of imperialism has developed in contemporary Africa, led by western states, financial institutions – such as multinational corporations and the World Bank – and increasingly powerful non-governmental organizations (NGOs). External political 64 Edge, 100. 65 Stock, 443. 66 Ibid., 138. 67 Edge, 70. 68 Stock, 443. 69 Ahluwalia, 9; Edge, 71. 70 Hoyle, 1.

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interference and resource exploitation, common during colonialism, are once again a threat.71 Common terms now used to describe Africa include “suffering,” “a region in turmoil,” and “a continent in crisis.” Presently, the average African is poorer than he or she was at the time of independence. A population explosion has further added to the troubles, and many nations are also debilitated by HIV/AIDS. Widespread human rights abuses common throughout the 1980s are still a persistent issue. Many of these concerns are tied to the numerous armed conflicts that have engulfed large areas of Africa. All of these problems are related, in some way, to the effects of colonization. Instability not only exists across states, but also across regions. With decolonization came the devastating effects of the militarization of society. Local conflicts have quickly developed into regional crises linked to the arbitrarily drawn borders that have separated clans and kin.72 In less than thirty years, civil war in Africa has accounted for over “half of all war-related deaths worldwide.”73 The majority of regional crises occur in the Horn, the Western Sahara, and the Great Lakes region. As stated by Young, all these crises have been “rooted in one way or another in illconsidered decolonization strategies driven by metropolitan [European] interests.”74 In 1996, half of the world’s 32 internal conflicts were in Africa, and in 2000, Africa was home to the world’s largest displaced person and refugee population at approximately twelve million.75 Media, former colonial powers, and the international community often cite “tribalism” as the main reason for post-colonial state failure. Similarly, many scholars have blamed “age-long hatreds” and have applied the term “atavism” to recent conflict, suggesting primitive savagery as the root cause for failure.76 These oversimplified, ahistorical explanations unfairly shift the guilt from former colonizing powers back to the colonized. When compared economically to other African nation-states, Uganda is doing relatively well; however, its current economic state is certainly far below what was expected at the time of independence. In 1986, there was a state of political and social collapse, which eventually returned to normalcy almost everywhere, except in the North.77 The International Monetary Fund has praised Uganda as “one of Africa’s most successful examples of economic recovery under structural adjustment.”78 An indication of this is that Uganda’s Human Development Index (HDI) has increased since 1990 by twenty percent. Despite this, progress has not been felt evenly across society. Even though structural adjustment programs have been seen as successful, the gains have still been minimal. Human development issues have crippled Uganda’s economy, as life expectancy remains at 39 years for males and 40 years for females,

71 Ankie Hoogvelt, “Globalization, Imperialism and Exclusion: The Case of Sub-Saharan Africa,” in African in Crisis, ed. Tunde Zack-Williams, Diane Frost, and Alex Thomson (London: Pluto Press, 2002), 20. 72 Young, 37. 73 Hoogvelt, 15. 74 Young, 25. 75 Zack-Williams, 9. 76 Rodney, 118. 77 Ibid., 100. 78 Stock, 443.

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while infant mortality rates sit at a distressing 89.3 deaths per 1000 live births.79 Thus, although Uganda has experienced some recent economic stability, numerous challenges remain. Today, the DRC also suffers from mass human rights violations, economic instability, and political unease. Since 1990, it is estimated that the Congo crisis has taken four million lives, the largest death toll since World War II.80 Life expectancy is at 47 years for males and 51 years for females, while infant mortality rates are at a devastating 98 deaths per 1000 live births.81 Indeed, the DRC is home to the highest percentage of child deaths worldwide.82 Because of corruption, greed, and external interference, the DRC lacks a strong central government, which poses numerous problems, such as the inability to deliver basic services. Consequently, its present reality, which stems from its colonial history, makes it difficult to conceive of a country in more distress. Yet, the DRC’s combination of mineral resources and geographical location make it “the most strategically important nation in Africa, with the potential to become one of its richest.”83 Indeed, as Wayne Edge notes, once peace comes to the DRC, it “could become the hub of an African Renaissance.”84 The DRC has reached a crossroads in which there may be a future of improved living standards and stability, or a return to a history of exploitation by outside actors, mass violence, and instability. Without sustained and sincere international assistance, it will certainly return to the latter. Today, Kenya sits at a somewhat more stable position than the DRC and Uganda. Although the economy has faltered in recent decades, it has certainly grown since independence. The capitalist development strategy that placed economic growth above equity has positively led to a more open economy.85 The capital, Nairobi, is now the leading centre of commercial and industrial activity in East Africa.86 One major challenge that Kenya faces, however, is its population explosion, as it has the highest growth rates worldwide. Although human development statistics across Kenya have improved, life expectancy is still only at 46 years for males and 48 years for females, while the infant mortality rate is 67.2 deaths per 1000 live births.87 Presently, Kenya, the country stumbled upon in the search for a faster route to Uganda, shows the most promise in terms of political stability and economic sustainability. Across Africa, advances and fallbacks exist in tandem. Positively, more than two-thirds of the continent’s population lives in countries with multi-party systems.88 Sub-Saharan Africa has also experienced a slight increase in average per capita income growth since 2000, an encouraging sign.89 Negatively, sub-Saharan Africa is the only 79 Edge, 98. 80 UNDP, “The State of Human Development,” in Human Development Report 2005, 20. 81 Edge, 30. 82 UNDP, 24. 83 Edge, 31. 84 Ibid., 32. 85 Stock, 141. 86 Edge, 71. 87 Ibid., 71, 68. 88 UNDP, 20. 89 Ibid., 4.

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region worldwide where the HDI has not consistently risen. However, this cannot be entirely blamed on colonialism, since the HIV/AIDS pandemic has also played a role more recently. Conclusion Many theories purport to explain Africa’s colonial legacy. 90 Surprisingly, colonialism is often overlooked, either due to the belief that “internal and external factors” are now too difficult and complex to fix, or because of “an unwillingness on the part of western analysts to admit culpability for a problem that has become unmanageable.”91 Recently, the most frequently cited scapegoats are capitalists and the African people. Other studies have blamed the instability in Africa on resource wars, failing to recognize the role of big business and western over-consumption. Modern-day Africa is too complex to be properly assessed through the application of a single theory. The current crises across Africa are rarely understandable without reference to various aspects, including colonization. 92 Yet, given Africa’s diversity, it is extremely erroneous to generalize. Africa is the second largest continent in the world, represents over one quarter of all United Nations membership, and is home to over 1,000 languages. It is important to recognize that it is not one single entity, but a continent of numerous peoples, languages, and beliefs; thus, a single theory or one-sided solution for the varied issues and crises playing out across Africa will never suffice. The effects of colonization have certainly had a negative impact on much of the African continent. Colonialism fostered negative impacts including political changes that led to instability and corruption, natural resource exploitation that benefited only the European settlers and colonial masters, mass human rights violations that targeted the native population, and the creation of the nationstates that did not respond to African needs. Presently, Africa also suffers from indirect effects, such as an inability to cope with famine, civil war, the HIV/ AIDS pandemic, and environmental degradation. Many of the African states that were once glorified as the pearls of Africa have fallen into chaotic civil war, while a limited number of the states that had few prospects have managed to stay afloat in the game of globalization. Today, the continent stuffers from economic and political depression that was almost unimaginable in 1960, when the thenPrime Minister of Britain, Harold Macmillan, spoke of the “winds of change” sweeping across Africa.93 No single reason can explain today’s reality, yet much can be learned from the processes and institutions implemented by the European colonial powers.

90 Popular theories to account for the state of instability and devastation in Africa include the modernization and dependency theories. For more detailed information about such theories, refer to Stock, 129. 91 Hoogvelt, 17. 92 Pal Ahluwalia and Paul Nursey-Bray, Introduction to The Post-Colonial Condition, Contemporary Politics in Africa, ed. D. Pal Ahluwalia and Paul Nursey-Bray (Commack, NY: Nova Science Publishers, 1997), 2; Stock, 117. 93 Hoyle, 1.

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Katie wrote “Tarnished Pearls” as an undergraduate at the University of Western Ontario, where she received a Bachelor of Arts in Political Science in 2007. She has since received her Master’s from the University of Waterloo, and is currently working as a teacher in South Korea. She can be contacted at [email protected]. Works Cited Ahluwalia, Pal. “Postcolonial Dilemmas: Political Succession in Kenya.” In The PostColonial Condition, Contemporary Politics in Africa. Ed. D. Pal Ahluwalia and Paul Nursey-Bray, 9-29. Commack, NY: Nova Science Publishers, 1997. Ahluwalia, Pal and Charmaine McEachern. “Founding Father Presidencies: The Case of Kenya and South Africa.” In The Post-Colonial Condition, Contemporary Politics in Africa, edited by D. Pal Ahluwalia and Paul Nursey-Bray, 82-97. Commack, NY: Nova Science Publishers, 1997. Ahluwalia, Pal and Paul Nursey-Bray. Introduction to The Post-Colonial Condition, Contemporary Politics in Africa, edited by D. Pal Ahluwalia and Paul NurseyBray, 1-7. Commack, NY: Nova Science Publishers, 1997. Almeida, Edgar F. “Was the Colonial Policy of Ethnic Self-Rule Responsible for the Divided Polity in Uganda?” MA thesis, University of Western Ontario, 2000. Bennett, George. Kenya, A Political History, The Colonial Period. London: Oxford UP, 1963. Dixon, Rob. “The Colonisation of Political Consciousness: States and Civil Society in Africa.” In Africa in Crisis, edited by Tunde Zack-Williams, Diane Frost, and Alex Thomson, 60-79. London: Pluto Press, 2002. Edge, Wayne. Africa. 11th edition. Dubuque, Iowa: McGraw-Hill, 2006. Hoogvelt, Ankie. “Globalization, Imperialism and Exclusion: The Case of SubSaharan Africa.” In Africa in Crisis, edited by Tunde Zack-Williams, Diane Frost, and Alex Thomson, 15-28. London: Pluto Press, 2002. Hoyle, Russ. “A Continent Gone Wrong.” Time Magazine, January 16, 1984: 26-27. Kiwanuka, M. Semakula. “Colonial Policies and Administrations in Africa: The Myths of the Contrasts.” African Historical Studies 3.2 (1970): 295-315. Kloby, Jerry. “The Legacy of Colonialism.” In Beyond Borders, Thinking Critically About Global Issues, edited by Paula S. Rothenberg, 88-106. New York: Worth Publishers, 2006. Ofcansky, Thomas P. Uganda, Tarnished Pearl of Africa. Boulder, CO: Westview

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Press, 1996. Oloka-Onyango, J. “Constitutional Transition in Museveni’s Uganda: New Horizons or Another False Start?” Journal of African Law 39.2 (1995): 156-172. Rodney, Walter. “How Europe Underdeveloped Africa.” In Borders, Thinking, Critically About Global Issues, edited by Paula S. Rothenberg, 107-125. New York: Worth Publishers, 2006. Shah, Anup. “Global Issues.” December 30, 2006. http://www.globalissues.org/ (accessed April 1, 2007). Stock, Robert F. Africa South of the Sahara: A Geographical Interpretation. 2nd Edition. Guilford Press: New York, 2004. UNDP. “The State of Human Development.” In Human Development Report 2005, 17-48. http://hdr.undp.org/en/media/HDR05_complete.pdf (accessed February 20, 2007). Young, Crawford. “The Heritage of Colonialism.” In Africa in World Politics, The African State System in Flux, edited by John W. Harbeson and Donald Rothchild, 23-42. Oxford: Westview Press, 2000. Zack-Williams, Tunde. “Introduction: Africa at the Millennium.” In Africa in Crisis, edited by Tunde Zack-Williams, Diane Frost, and Alex Thomson, 1-14. London: Pluto Press, 2002.

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Young People in the Field

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Jillian Meets Real Meat “Well, pretty black, brown, and red one, I guess today is your day to die” Jillian Merica

My parents are both shop-aholics: an affliction scoffed at by many, but a true addiction nonetheless. My father finds great comfort in food, so he buys an overly abundant supply. Even though the closest grocery store is five minutes away, our fridge is overstocked and our basement’s walk-in storage closet is filled with shelves of cereals and canned vegetables. Because food was never a worry for me, I never realized what it means to produce all the food one needs to survive. I never realized, for instance, what it meant to kill a chicken – that is, until I went to Sanankoroba, Mali. Upon arriving, I was shocked by the food situation. I expected to see undernourished people, but I never thought about where food came from and how it was produced – the many extended hours, weeks, and months of cultivation and rearing that resulted in such a small output. I never thought about the energy put forth on daily long walks to the market under the blazing sun to sell freshly picked vegetables and meat slaughtered earlier that morning. I wandered past stands crammed with greens, mangoes, and cow parts, but never saw chicken in the market. Chicken was very expensive and only available at boutiques with electrically-powered rotisserie ovens. They are highly desired, but they are small and take months to raise, yielding only a small output of tender meat. I loved chicken before going to Mali. It was the only meat I would actually eat. Now, I admit that I did enter Mali with some sense of how to cultivate and gather food. I spent my childhood summers in Northern Michigan with my parents’ families where I watched my uncles hunt, gut, and cook animals before eating them for dinner. I spent months on my grandfather’s cherry farm watching the cherry picker machines shake cherries from trees and helped my grandmother weed the garden and pick fresh vegetables and strawberries. I have talked with my grandfather about farming, crop rotation and placement, farm maintenance and development. I have heard endless stories from my father about the years of hard labor he put into Grandpa’s cherry farm, and the difficulties and successes involved. Yet, I never realized what it meant to kill a chicken. Despite all that I had seen and learned from my family while living my “first world” life, I never stopped to think that for every two chicken wings I ate, I was killing a chicken that took months of hard labor, vast resources, and considerable energy to raise. My epiphany concerning chickens occurred during a three-week apprenticeship with a nurse midwife, Margo. I spent the majority of that time shadowing her in a rural clinic’s maternity ward where life was very slow, something I had somewhat expected. Although we could count on a birth almost daily – this specific clinic covers the needs of 30,000 people over a wide geographic area where the average birth rate is seven children per woman – the rest of the time there was not much to do besides watch the nurse’s chickens. As a result, I became an expert on chicken behavior. All day long, I sat outside,

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rotating my chair position to stay out of the blazing sun, and tended to the chickens. Margo had at least twelve: two grown hens, one rooster, and about nine chicks. They were surprisingly beautiful, and, maybe not so surprisingly, dumb. They ran around endlessly in search of food, always in a pack picking at the same morsels. With the flick of a wrist you could scare the living daylights out of them, and their stunted memories would bring them right back to you within minutes. Most days, they were the most interesting things around. Because I hated all other meats in Mali, I developed an iron deficiency, and spent most days imagining those chickens roasting in the pot – how the savory meat would satisfy my cravings, how that pretty black, brown, and red one would fill my belly. I began to wonder why Margo didn’t just kill one. But, as I watched the chickens, I began to realize that in the three weeks I had watched the chicks, not one had come near reaching mature size. It would take months for those chicks to reach a size suitable for slaughter and dinner. Much to my chagrin, I began to realize what it meant to eat a chicken. Eating a chicken meant waging a bet. Raising new healthy chicks was expensive. They needed good feed, space, and protection from predators. Margo could keep the chickens and count on a few eggs and, once in awhile, the hope of more chicks. But killing that chicken would mean the end of future revenue or protein sources: a onetime shot. Was it worth that risk? Probably not. These were decisions I personally never had to make about food. While I knew meat was more expensive at the supermarket than other products, it was always there and seemed to appear in an infinite supply, magically reappearing every day, clean and sliced. I never realized that, for millions of people around the world, killing a chicken meant taking a risk, that it meant compromising future production and food security. Indeed, eating that juicy meat was a reward for diligence, hard work, and careful planning. I came to see that my idea of consumption in America was completely unsustainable and unrepresentative of just how precious and expensive our food sources are. Although I was raised on thick meaty Midwestern sandwiches, since my time in Mali, I have decided to stop eating meat. I have never ascribed to ideologies against animal cruelty or found anything inherently wrong in eating meat, but now I realize the true impact of eating a chicken. It is a privilege, one that should be enjoyed sparingly, and with due consideration. Jillian recently graduated from Smith College in May 2009 with a Bachelor of Science in Neuroscience, and is currently pursuing a Master’s degree in Teaching and Instruction at the University of Mississippi with the Mississippi Teaching Corps. She worked in Mali from February to May 2008 on a study abroad program with the School for International Training (SIT). She can be contacted at [email protected].

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Integrating Values into Development Fouzia’s Story Danice Brown

Fouzia was one of the first youths I met in Tendrara, Morocco. I was sitting in the youth center, doing what I did best during my first few weeks in town: observing. Across the room, the members of the theatre club weren’t clutching pens and notebooks like I was; but they were as attentive to my actions as I was to theirs, both of us assessing each other, waiting to see how our relationship would grow. Fouzia, however, was never one to wait. She sauntered right across the concrete floor, kitty-heels clicking and long white skirt swooshing with her steps. Plopping herself down in a chair next to me, she crossed her legs and turned her knees towards me, taking both my hands in hers. “What’s your name?” she began in stronglyaccented but quite confident English. “Ana smiti Dounia,” I replied in similarly-toned Arabic. From that moment, we recognized in each other a kindred spirit. We soon fell into a steady banter of Arabic and English, words of two different languages intertwining like her fingers with mine, and within minutes she had secured my commitment to come to her house for lunch the next day. Mission accomplished, she strutted easily across the wide moat that remained between the rest of the members of the club and myself. Walking over the water of that cultural divide was just the first of many feats I would see Fouzia perform in the year that I have known her. Through my interactions with Fouzia, I have been struck over and over again by her multi-leveled talents – her social poise and friendly mannerisms, her enthusiastic involvement in activities at the youth center, her vociferous consummation of any English lesson she could find, not to mention her theatrical talent. She can navigate a conversation with my American visitors one moment, and greet a conservative town elder with respect and composure in the next. She is constantly knocking on the door of my house asking for help with an English project that she decided to undertake on top of her regular lessons. She has helped me with the smallest details of events I have coordinated in the youth center, taking me to buy just the right cookies and bringing plastic cups from her house to an AIDS Education Conference. She has even worked to organize guitar lessons in the youth center, connecting several students who own guitars with a teacher who knows how to play. Sometimes I joke with her that she is doing my job, and I’m only half in jest. In fact, she is exactly the kind of youth leader I am looking for – someone who has the initiative and connections to continue projects I begin, and to start some of her own. Someone who could make my position obsolete. Fouzia tells me that she gets her love of song from her father, L’Haj Mubarak. L’Haj has a very important role in the hierarchy of Tendrara. He is one of the oldest men of the town, a retired soldier who has an extensive social network with the local sheiks and other elders and even further-reaching familial networks due to his propensity for marriage. Halima, Fouzia’s mother, is his eighth and currently only wife; but between his previous wives and Halima’s fourteen siblings (her father, too, had several wives), Fouzia is related to the greater half of her small community.

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Certainly, she comes from a prominent and active family line. Last spring, I approached L’Haj to ask him if he would allow two of his daughters, Fouzia and her younger sister Bouchra, to take advantage of a scholarship program offered by my organization, which would send them to a two-week language immersion camp in a town on the other side of the country. I was excited for them to have the opportunity to travel to a part of the country they would otherwise never see, and to interact with motivated children their age from more liberal communities of Morocco. I also brought a schoolteacher with me to stress the relation of this camp to their academic advancement. L’Haj Mubarak listened to us for about fifteen seconds before beginning his rant: “Do not involve yourself in my daughters’ lives! I want my daughters to go to school and return to the house! School and the house, you understand? Nowhere else! Leave my house! Leave it and don’t come back!” This loss of such a valuable youth leader in the community saddened me greatly, but more importantly, it pushed me further than I thought I would go in my approach to women’s development and cultural integration. This autumn, by sending a veritable army of local community and family members to solicit L’Haj daily for about seven days, I succeeded in securing his permission to let the girls participate in a local theatre festival, even after their half-brother told him it was shameful for them to be rehearsing with older boys in a public space. This small victory was a result of much more pestering than I ever would have attempted in a similar situation in America, and reflects a different attitude towards authority in Moroccan society. In America, I would never question the decision of a child’s parents. But in a community where the village raises the children, I, as a member of that village, have felt more at liberty to challenge the father’s methods of raising his children. Through this broader application of societal norms I was able to question one of the most established but controversial behaviors of the citizens of Tendrara – their treatment of women. By engaging in development work here in Morocco, I am constantly pushing for progress. But societal progression, contrary to what students of development may believe, does not follow one simple linear direction. In any situation there are many decisions, many paths, and many possibilities. How do I choose what is the correct course to promote? Personally, I formulate my conception of the trajectory of the societal norms of the community from a mix of my understanding of Moroccan culture and its current direction, and those rights and entitlements from my own background society that I consider universal. In the case of Fouzia’s attendance at English camps, for example, I saw that many of the volunteers from larger, more modernized cities in Morocco had no trouble securing permission for their students to attend camp. Generally, larger locations prove more adaptable to change than small conservative towns, and serve as good indicators of the direction in which society is headed. Thus, I have deduced that Moroccan society is becoming more open to girls’ education. This theory can be confirmed statistically – according to UNESCO, female enrollment, participation in, and completion of secondary education in Morocco has been increasing for over a decade (http://portal.unesco.org/education/). Specifically, I have noticed an increase in the education level in my small town itself. Fouzia’s mother never entered a school, and all her daughters are studying. In fact, the situation seems to be the same for most families I visit: usually the mother has much less education than the father, but the children are receiving equal education – regardless of gender – at least until the

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secondary level, and often beyond. When analyzing Fouzia’s attempt to attend Language Immersion Camp from the perspective of my own background, the situation became even more obvious. Coming from a society where parents are willing to make a significant financial investment in the higher education of both their sons and daughters, I clearly believe that equal access to education is an important value. Its presence in the UN Declaration of Human Rights confirms for me that equal access to education is not simply an American value but a universal entitlement. So, the case for education seems fairly straightforward – an opportunity for Fouzia and her sister to attend an educational camp is positive in the eyes of all. Unfortunately, I was not so successful in convincing L’Haj of this. However, when addressing her participation in theatre club activities, an arena in which I was actually persuasive, the situation was perhaps a little more ambiguous. In trying to determine the broad trajectory of a society, it is also helpful to look at what interests the youth. Almost all of my colleagues find requests for theatre or music activities in the youth centers in which they work, so clearly there is an attraction to the performing arts. Fouzia and her sisters often talk to me about music and theatre activities that they wish to pursue, and ask me to teach and lead expressive art activities. During my newcomer days in Tendrara, I was often frustrated at the quick requests for lessons in the subjects in which I am skilled, such as music, because I first wanted to spend my time assessing the needs of the community to determine what type of skills were actually necessary. One of these community’s requests, however, was present from that first rehearsal I witnessed: theatre. The theatre club was the only active group in the youth center when I arrived there. As such, the general interest in theatre dictated the focus of my first year grant applications. With the assistance of small project funds, we were able to participate in two theatre competitions, and hold three theatre festivals in the past year. It was through this interest that I observed the value that Tendrarans place on the performing arts. However, I can also see how traditional Moroccan society, with its focus on modesty, would consider a woman on a stage to be shameful. Furthermore, theatre rehearsals involve women and men together in a fairly casual social setting, an almost unheardof occurrence in rural Moroccan society; but again, this is something that is becoming more and more common in more urban settings. So I have concluded that, while co-ed theatre activities are still scandalous for small-town Morocco, they comprise an additional small step in the progression towards gender equality. My personal background of piano lessons, choirs, and musicals led me to be naturally inclined to support the involvement of both boys and girls in artistic endeavors. My studies of world music in college and particularly my research on Rwandan children’s use of song in casual forms of therapy broadens this focus on the importance of the arts as a means of expression for both men and women from simply an American value to a more universal concept. I want to stress that I don’t know if this system of using a combination of my understanding of Moroccan society along with the values that I consider universal to determine the direction of societal progress is some magic formula that will help me make the right decisions. Instead, the goal of this analysis of two small incidents during my service is to demonstrate that even small choices made in development work are not morally objective. Societies are not linear – they do not progress along

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one direct trajectory towards a clear goal, but, rather, move forwards and backwards, sidestepping obstacles and oftentimes making wrong turns along a route to an obscured destination. And in today’s globalized world, members of many societies do what I am doing everyday: combining the values of various cultures and traditions to determine that next “right” step. I have often wondered if Fouzia herself, who could do my work in the youth center with so much more ease than I, would also be a better judge of which way to turn at these moral forks in the road. It is clear that she longs for a society that is vastly different than that of her father’s generation, but could she achieve that change without my assistance? Is that assistance an intrusion of my culture on hers, or a broadening of her horizons? How much of what she wants is affected by her interactions with me? How much of it is part of that radical push for drastic societal change that is common to youth the world over? How much is a true indicator of the direction in which Moroccan culture is headed? My attempt to do even the smallest, simplest piece of development work here in Morocco has been a struggle to wade through divisions and focus on commonalities, or at least what I perceive them to be. And in order to make that perception, I had to rely on a curious mix of research, interactions with Moroccans, my understanding of values within Moroccan society, and my own moral compass. I don’t believe I could ignore any of these perspectives when doing development work. Clearly, development is by no means a simple, formulaic list of right and wrong. How these shades of grey are interpreted can affect whole societies, or at the very least, one vibrant, enthusiastic Moroccan girl named Fouzia. Danice is currently in her second year as a volunteer in the U.S. Peace Corps in Morocco, where she continues to work with Fouzia in a growing guitar club, and separately with the theatre club that recently qualified for a national AIDS awareness theatre competition with the help of a Small Project Assistance Peace Corps Grant. She visits Fouzia’s family regularly, and has come to regard them as her own family. A video of Fouzia and her family can be found at: http://www.youtube. com/watch?v=-X9HcWzN47U. Danice attended the University of Notre Dame and earned a Bachelor’s Degree in Anthropology and Music. She can be contacted at [email protected].

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Call for Papers SCOUT BANANA, in conjunction with Michigan State University’s African Studies Center and Office of International Development, invites you to submit a manuscript to Volume II, Issue II of Articulate: Undergraduate Research Applied to International Development. Articulate is an undergraduate journal that publishes academic papers and writings on issues in international development, focusing on African studies and health care issues. It is a forum for students to contribute to, as well as initiate, debates in international development. Undergraduates remain a vital, untapped force for new ideas and perspectives within the development dialogue. Our goal is to spark, share, and spread knowledge to create innovative change now. Primary criteria for inclusion in the journal are quality of research, relevance, and originality. We ask for submissions of roughly 15-20 pages double-spaced, citations formatted according to the Chicago Manual of Style, and an abstract of 200 words. We also ask that the author’s name, major, college, and university appear on a separate cover sheet, with no reference to the author within the manuscript. Potential topics include, but are not limited to: • The effectiveness of foreign aid, microfinance, and social enterprise in Africa • Intersections of gender, religion, ethnicity, and sexuality in African development • Ethics and development in African countries • Historical analyses and case studies of health care programs in Africa • Politics of water and medicine in Africa • The role of African youth in development programs and projects • Effects of conflict and forced migration on health care and development

Articulate is also seeking brief reflective essays on your experiences in Africa, as well as reviews on literature relevant to Africa, development, and health care. Reflective essays are 2-3 single-spaced pages and can take a variety of creative forms. They should explore development work from the perspective of a young person (under 30) from the Global North entering the Global South. Was it how you thought it would be? What did you like and/or dislike about it? What do you wish you had known when you were just “studying,” as opposed to working, in Africa on health-related issues? Other themes may be considered with consultation from the Editor-in-Chief. Literature reviews are 2-3 single-spaced pages and are meant to keep Aritculate’s readers abreast of current works and on-going debates pertinent to development, Africa, and health care. Reviews must provide a careful, thoughtful analysis and critique of a work’s main themes, objectives, arguments, and conclusions. They should include at least three titled sub-sections: an introduction that includes a synopsis of the work; an analysis that considers what, if any, assumptions underlie the author’s thinking and, if evidence is cited, how well it supports the work’s main objective; and a conclusion that summates your analysis and states the overall merits and/or shortcomings of the work. Manuscripts will be accepted until Wednesday, September 16, 2009, with an intended publication date during November 2009. For submissions, please contact the Editor-in-Chief at [email protected]. For more information, check out http://scoutbanana.org/articulate.

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Articulate Style Sheet Documentation Guidelines Articulate adheres to the Chicago Manual of Style’s humanities, or note-bibliography, format system. All citations and references of a submission to the journal must align with the guidelines outlined here. For more detailed information, please refer to the most recent edition of the manual. Works Cited This page should appear at the end of the paper, but before any figures and appendixes, and should be arranged in alphabetical order according to the authors’ last names. All entries with no author should be placed before those with authors, and should be arranged alphabetically according to the title of the work (keep in mind that an organization can act as an author). In the examples that follow below, the first entry shows the format of the first note as it should appear in the text proper. These should be placed in footnotes, and ordered sequentially by number. After the first note entry for a work, all subsequent references to that work should be formatted as “Author’s last name, page number.” If you have referenced several works from the same author, include the title in secondary notes, as in, “Author’s last name, title of work, page number.” If no author is given, include the title and page number. If there is no page number (e.g., a website), simply include the title of the reference. The second entry shows the format of the note as it should appear in the works cited page. Note that each line after the first is indented. Also note that there is no use of italics or underlining: book titles are left as regular, plain text, while everything else – sections of books, websites, articles, papers, presentations, etc. – are placed within quotation marks. Book One author 1. Ferdinand Oyono, Houseboy (London: Heinemann, 1980), 27. Ake, Claude. Democracy and Development in Africa. Washington, D.C.: Brookings Institution, 1996. Two authors 2. Toyin Falola and Matthew Heaton, Health Knowledge and Belief Systems in Africa (Durham, N.C.: Carolina Academic Press, 2008), 94-97. Feierman, Steven and John Janzen. The Social basis of health and healing in Africa. Berkeley: University of California Press, 1992. Three or more authors 3. Edward O. Laumann et al., The Social Organization of Sexuality: Sexual Practices in the United States (Chicago: University of Chicago Press, 1994), 262.

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Laumann, Edward O., John H. Gagnon, Robert T. Michael, and Stuart Michaels. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press, 1994. Chapter or other part of a book 4. Gustavo Esteva, “‘Development,” in The Development Dictionary: A Guide to Knowledge as Power, ed. Wolfgang Sachs (London: Zed Books, 1992), 6-25. Hoogvelt, Ankie. “Globalization, Imperialism and Exclusion: The Case of SubSaharan Africa.” In Africa in Crisis, edited by Tunde Zack-Williams, Diane Frost, and Alex Thomson, 15-28. London: Pluto Press, 2002. Preface, foreword, introduction, or similar part of a book 5. Nancy Birdsall, introduction to Reinventing Aid, ed. William Easterly (Cambridge, MA: MIT Press, 2008), xi–x. Keim, Curtis. Preface to Mistaking Africa: Curiosities and Inventions of the American Mind, by Curtis Keim, xi–xii. Boulder, CO: Westview Press, 2009. Journal article 6. Sally Matthews, “Post-development Theory and the Question of Alternatives: A View from Africa,” Third World Quarterly 25.2 (April 2004): 373-384. Cohen, Michael A., Maria Figueroa Küpçü, and Parag Khanna. “The New Colonialists.” Foreign Policy 167 (July-August 2008): 74-76. Popular magazine article 7. Russ Hoyle, “A Continent Gone Wrong,” Time Magazine, January 16, 1984, 26. Sachs, Jeffrey. “A Deadline on Malaria.” Scientific American, July 29, 2008. Newspaper article Newspaper articles may be cited in running text (“As William Niederkorn noted in a New York Times article on June 20, 2002, . . . ”) instead of in a note, and they are commonly omitted from a works cited as well. The following examples show the more formal versions of the citations. 8. Mangoa Mosota, “Report: Recession will affect HIV plans,” The East African Standard, July 9, 2009, Health section, Kenya edition. Timberg, Craig. “How AIDS in Africa was Overstated; Reliance on Data From Urban Prenatal Clinics Skewed Early Projections.” Washington Post, April 6, 2006, section A, Final edition.

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Book or Movie review 9. William Easterly, “The Big Push Déjà vu,” review of The End of Poverty: Economic Possibilities for our Time, by Jeffrey Sachs, Journal of Economic Literature 76.1 (February 2005), 1-22. Seitz, Matt Zoller. “Healing Cultural Wounds.” Review of A Walk to Beautiful, directed by Mary Olive Smith and Amy Bucher. New York Times Movie Review, February 8, 2008. Thesis or dissertation 10. Nic Cheeseman, “The Rise and Fall of Civil Authoritarianism in Africa: Patronage, Participation in Political Parties in Kenya and Zambia” (Ph.D. diss., Oxford University, 2008), 31-37. Almeida, Edgar F. “Was the Colonial Policy of Ethnic Self-Rule Responsible for the Divided Polity in Uganda?” MA thesis, University of Western Ontario, 2000. Paper presented at a meeting or conference 11. C. Everett Koop, “Health policy working group briefing: the Surgeon General’s report on AIDS” (presented in Washington D.C., September 24, 1986). Sen, Amartya. “Health in Development.” Keynote address presented to the Fifty-fifth World Health Assembly, Geneva, Switzerland, May 18, 1999. Website or Blog Web sites may be cited in running text (“On its Web site, the Evanston Public Library Board of Trustees states . . .”) instead of in a note, and they are commonly omitted from a works cited as well. The following examples show the more formal versions of the citations. 12. Hans Rosling, “Hans Rosling on HIV: New facts and stunning data visuals,” TED, http://www.ted.com/talks/hans_rosling_the_truth_about_hiv.html. Stiglitz, Joseph. “Making Globalization Work.” Project Syndicate. http://www.project-syndicate.org/commentary/stiglitz74 (accessed July 27, 2009). Blog entry or comment Blog entries or comments may be cited in running text (“In a comment posted to the Becker-Posner Blog on March 6, 2006, Peter Pearson noted . . .”) instead of in a note, and they are commonly omitted from a works cited as well. The following examples show the more formal versions of the citations.

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13. Alfred Dunn, comment on “From First E-mail in Africa – 20 Years of mHealth,” The Global Health Magazine Blog, comment posted June 5, 2009, http://www. globalhealthmagazine.com/guest_blog/from_first_email_in_africa_20_years_of_ mhealth/ (accessed July 23, 2009). Alanna Shaikh Global Health Blog, The. http://globalhealth.change.org/.

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Office of International Development Michigan State University

African Studies Center Michigan State University

James Madison College Michigan State University

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issn 1943-6742