Friday, November 28, 2008

AIDS Attacks, a deadly snake and more

The last few days in Rwanda have been filled with AIDS Attacks in remote villages. Unlike our street outreach in urban areas where it is easy to find large numbers of young people to talk with -- in the countryside, people of all ages are curious whenever they see a crowd. And our AIDS Attacks always generate crowds. Adults leave their chores and amble over. For the first time on this trip, I was hearing little children saying the local name for “White Man” because these kids rarely if ever have seen one in the flesh.

I have been traveling with an assortment of young people from different non-government organizations (NGOs) that we are partnering with: RAPP SIDA, Rwanda Youth Network and Together As One (a Christian Ministry). I offer my expertise to any group and in return, they send volunteers. Steven, Christella, Emmanuel, Peter, Issa, Suleiman and Andrew joined us two days ago and we had encounters with many people that said they had neither heard of nor knew anything about AIDS. And this is in central Africa where HIV rates have skyrocketed! Others said they knew a killer disease existed but didn’t really understand how it was transmitted. They all wanted to know more.

Well, most everyone. In a market, one young motorbike driver (a local taxi) turned away in disgust when I offered him a card. I told the other drivers that they needed to talk with him later because denial could lead to mistaken transmission. A few minutes later, he returned from taking his fare. I was encouraged until he refused my offer a second time. He wanted to be sure his friends knew he was smarter than they were.

On a dusty road to nowhere, we met two sisters with their young babies. Their conversation centered on philandering husbands. They asked me how a wife can keep her man from sleeping around. Not being a marriage counselor or an expert in this field, I told them they should use the argument that these men will have a greater chance of getting HIV -- and AIDS is a difficult way to die. It certainly isn’t sexy for the ladies. Once the virus has entered their bodies it will never go away until the day they leave this earth.

I stressed that women should use the argument that their HIV-positive men will be passing AIDS to their babies, perhaps their baby sons. In many parts of Africa, boys are favored by fathers who see the number of their male offspring as a sign of virility while a girl, if the first born, is said to bring wealth (this is based on the exchange of the traditional dowry of cows upon marriage). Christella read the information off the cards we pass out because the sisters couldn’t understand French or English. I was really happy that Christella was with us at these moments when we need to get the AIDS message to vulnerable women. Her younger friend Sarah had dome the same thing the day before.

In my previous blog of yesterday, I told you about the genocide prisoners whom we met along another country road. They traveled in packs without any guards or police escorts. I looked into one older man’s red eyes trying to search his soul. No luck. He was probably about 45 years-old and his face showed scars. When I greeted him, he smiled at me and shook my hand vigorously. Most likely, he had no idea that a side of me was horrified to think that this was one of the mass murderers who slaughtered babies and children out of irrational tribal anger. Andrew was especially effective when talking to these men about the sexual transmission of HIV because even though prisoners are locked away from female interaction, sex is still in their lives. It is not that they are homosexual but that they remain sexual even in lockup.

We stopped along a major thoroughfare to talk with three young men between the ages of 17 and 20. They were playing soccer with a ball made out of a a form of pandanus leaf. It actually bounced like a regular ball. One said that he knew about AIDS because members of his family were sick. Soon more people joined us from intersecting byways. While Steven translated for me, Christella spoke mostly to the young women and Andrew talked to older couples, perhaps parents of the football players. By this point, my volunteers knew everything that I was going to say and they were very effective in getting the AIDS message across. I try to keep our attacks between ten and twenty minutes to distribute the cards, explain the relevant information and answer their questions. As we left, the crowd dispersed in every direction carrying the news on to their friends.

Rose and Jimmy joined Andrew and I yesterday as we headed north of the city. Not traveling with a set itinerary or even a destination in mind, we looked for our next group. As we crossed a small river with five or so men digging up the muddy silt (to sell to farmers), Andrew yelled, “Look, they are killing a snake!” Damned if I couldn’t see anything because my eyesight is so bad in the bright African sun. I could only make out one man smashing his shovel repeatedly in the grass. A crowd had gathered on the bridge staring at the scene with children holding onto their mothers. Seizing the opportunity, we stopped and got out of our car for an AIDS Attack but Rose stayed back whispering, “I hate snakes.”

Between the deadly snake and me in a bright Hawaiian shirt, the attention of the crowd was divided until the men in the river brought the wounded -- but still writhing reptile -- up to the crowd that quickly formed in a circle. It was a little less than a meter long but quite thick. Somebody said it must be a young snake. I asked Andrew if he knew what kind it was and he said a cobra but I wasn’t sure.

Standing less than five feet away, I was not anxious because the poor thing was badly injured and unable to strike. Andrew introduced me and I began speaking -- yet we all occasionally glanced down at the ground whenever it twisted and constricted. After speaking, one outspoken woman spoke animatedly, asking how she could follow my advice and avoid blood and bodily fluids when it was her task to take care of her family members who were already sick. I suggested getting rubber gloves like those used for dish washing but Rose said the cost would be prohibitive for such a poor person. I then suggested asking a clinic for a pair of latex ones or for NGOs to arrange their distribution in areas where AIDS is prevalent.

At another stop at a settlement on the side of a hill overlooking a valley of rice paddies, we had an unusual encounter that made Rose angry (she always has a smile on her face). I was talking with a man who ran a cooperative (mostly selling kasava, plantains and rice from a sack marked “Thailand”) when I was told there was a man with AIDS down the hill who wanted to talk with me. So I gingerly made my way down a steep path to a group of young men playing a game of chance. Now, I have two rules when doing street outreach. First, I never engage a drunk in conversation and never interrupt people gambling because you will get blamed if they lose. One man was doing a bit of both.

My intuition was tired but as long as there are people to talk with, I am like the Energizer bunny. I told him that I was saddened by his condition but he still had a good life to live. I suggested he tell his story to other young men to help them learn from his example. As Rose translated, he continually interrupted, laughing and obnoxious. It was clear that she was getting upset. I recognized the Rwandan word for “joke” and then “serious.” Evidently, he was giving kindly Rose a tough time by showing off in front of his peers. However, none were laughing – they were clearly uncomfortable with his rudeness. Rose had been telling him the names of clinics he could visit but he showed no interest. She decided then that he was not sick with AIDS but just playing around. I occasionally run into these types and when I do, I have to make a snap decision. Quickly judging that he was not belligerent but simply an ass, I asked Rose to translate for me.

I ignored him and spoke to his peers directly. I said that if people ignore good advice then they run the risk of making a mistake that could result in a shortened life. I explained that Rose and the other volunteers were giving their time freely and every thinking person should take advantage of hearing the truth about HIV, suggesting that educated peers should help their friends learn the facts. I then asked the boys to help any friend that needed advice. Leaving the group, I smiled at the rude one, shook his hand and said, “bon chance.”

AIDS Attacks are interesting in every regard. I learn something each time. As we drove away, my mind turned to the scarred face of the prisoner, the two sisters, the bike driver and the dying snake surrounded by his human enemies…

Thursday, November 27, 2008

Rwanda Genocide Redux

Flying over the green, rolling hills of Rwanda, I gazed down at the maze of red-dirt rural streets with a sickened feeling in my stomach. I couldn’t help but think that here is where hundreds of thousands of mutilated bodies lay just fourteen years ago. In one of the worst acts of genocide in the recent past, 800,000 Rwandans (mostly from the minority Tutsi tribe) were hacked to death in 1994. Then, the entire world including powerful stalwarts of human rights like the UN, France (Rwanda’s colonial overseer) and the U.S. did nothing constructive to intervene and stop the mass killing. We sat on our hands and said it wasn’t our problem. Incredibly, this all happened in only 90 days, making it a monthly death rate that rivaled and exceeded any similar time span during the Holocaust.

Rwanda has made an almost miraculous recovery since those horrific days. A policy of national reconciliation has been in effect and most Rwandans see themselves as one people, not separate just members of the Hutu and Tutsi tribes. Following the genocide, massive amounts of foreign aid flooded the country, much the result of deep remorse and guilt. Some people now call this country the Switzerland of Africa because of its keen sense for encouraging business investment. On the surface, all looks wonderful but lurking underneath are personal stories that tell another story. Let me explain.

People are still walking the streets who were the murderers amidst others who are the surviving victims. A foreign visitor like me has little idea of who is who. In the intervening years, many have gone to jail but at least 10,000 of the worst offenders escaped into the eastern Congo (DRC) where they are continuing the killing and raping of innocent citizens. Today, the media is full of reports about the renewed fighting in the Congo (the next destination on my trip). Rwanda is unofficially involved battling rebel elements inside the DRC. Under President Kagame, himself a onetime Tutsi rebel leader that fought the Hutus, Rwanda has tried mightily to put this chapter of its history to bed but it goes on and on. The plunder of mineral resources plays a major role in the regional conflict.

I work with young volunteers of all persuasions, because the only battle that I want to fight is the war against teen HIV/AIDS. I have been walking the hilly streets of Kigali and in remote areas to the East to convince youth that HIV is now their worst enemy.

Andrew and Christella have been accompanying me on my outreach that we refer to as “AIDS Attacks.” Both are dedicated volunteers in spreading the gospel of taking personal responsibility for one’s behaviors to avoid the silently spreading disease. Christella is now 19 years old and a student entering university. A very pretty young woman, she has a shy demeanor upon first glance and speaks in a low voice. Yet, she has become a most powerful spokesperson in my crusade. Today she told me the story of he memories as a five year-old girl, when the mass killings began in April of 1994.

She remembers her frightened mother taking her by her hand and scurrying through the bush to the home of her mother’s best friend, a member of the majority Hutu tribe. Christella remembers her mother begging her best friend to hide her daughter from the marauding bands armed with machetes. The Hutu woman, named Bendetta, was worried and said she would take in Christella but could not take her two year-old baby brother out of fear for her own safety. Bendetta insisted that Christella must always claim that she was her youngest daughter and never mention her real mother. After a tearful goodbye, Christella saw her mother for the last time as she disappeared out the back door and into the night.

Over the next few months, angry men with blood on their clothes the color of the bright red soil of Rwanda, came to the door and demanded to know where Tutsis were hiding. Scared out of her mind, little Christella always said that she was the youngest daughter in Bendetta’s family. It worked and she survived -- but not her mother, father and younger brother. She knows that her parents were hacked to death and her younger sibling was repeatedly bashed against a wall until his brains spilled out onto the ground wet with blood of others. During the three months the killing went on, Christella witnessed gruesome murders and saw the decaying bodies that littered her neighborhood.

Andrew was eleven years old in 1994. Months before the Hutu radio stations urged their people to kill every Tutsi, he knew what was coming because every night people were taken out of their homes and disappeared. He ran into the bush along with other boys without saying goodbye to their parents to save their own lives and become boy soldiers fighting the Hutus. At first, he and the other boys cooked the meals while the men went off to fight. Andrew also acted as a medic, dragging the bodies of dead and wounded back to their hidden camps. He told me that some people still call him doctor, based on his knowledge of dressing wounds.

Andrew received his first gun a few weeks later and did what every soldier must do. When he returned home after the Hutu army was defeated, his parents cried for joy as they thought he had died. He cried also because miraculously his parents had survived too, hiding in the hills. He estimated that he must have seen hundreds, if not thousands of dead bodies during this period of time.

Today, we went to some remote villages. Making our AIDS Attacks wherever we see young people, we drove down a bumpy road. We stopped by a one room hut talking with a few teens who were tending goats and small cows. None of them had heard about AIDS. We were passed by scores of prisoners going to their rural barracks after a hard day of doing road improvements and construction. Dressed in blue garb, each man carried shovels, picks, axes – and machetes. Andrew told me that these were the men who were responsible for the genocide. I talked with many of them about AIDS and how it was an unseen killer that was spreading through Rwanda. My French language business cards with AIDS facts and advice did not help in this rural region where illiteracy is high. So it was Andrew and Christella who told these men how to save their lives.

Our TeenAIDS’ mission is an equal opportunity one. We talk with everyone. The men thanked me and my volunteers for sharing the information. Soon they trudged down the red-dirt road that went into a lush valley. As I saw the blue shirts and sharp tools disappear, I shuddered to think that only fourteen years before, they were the ones killing innocent babies, children, teenagers, and adults. And to think that Christella and Andrew were eager to share their knowledge with these men!

They say politics makes strange bedfellows. Well, the necessity of fighting AIDS makes for unusual liaisons and today was not the exception.

Wednesday, November 26, 2008

Leaving Khartoum with Fondness

Without a doubt, my work in Sudan has been among the most pleasurable and fruitful that I can remember in many years. What a surprise! The Sudanese people are truly some of the friendliest I have ever met, and I travel to many countries all over the world. It is sad that the politics between the United States and Sudan and the issue over the tremendous suffering in the Darfur has complicated our view of this wonderful people. I tend to let the governments fight over their issues while I only want to concentrate on helping young people learn more about AIDS prevention. Mission accomplished!

We did many AIDS attacks in Khartoum. This was an unusual event for most Sudanese, who are not used to foreigners comeing up to them on the streets, especially someone who looks like me. However, due to their natural friendliness, this made every encounter a good one, and this direct street approach has captured the imagination of the Sudanese. For example, we were driving by the University of Khartoum Graduate School of Engineering and Architecture and we saw 45 male students milling around outside. Just as soon as I started to say to Dr. Samah from SNAP to stop, she also said stop, as she was excited about doing another AIDS attack. Immediately we were surrounded by the young men, most of whom speak English. They were full of questions about AIDS and sex. It turned out they were waiting on going to a fishing trip to the Nile and as we left their bus pulled up.

Another time we stopped to pick up sandwiches for our volunteers on our way to an all day training conference and I met a young 16 year old who was very much interested in AIDS and who was intrigued by the fact that I was doing this work and that we had so many volunteers working with me. Whether the groups are large or small, I believe AIDS attacks will be part of the Sudanese tradition in the future. I also introduced our stop action theater at two major training conferences, one with representatives of student organizations throughout Khartoum and another at UMST University. Stop Action Theater is my version of improvisational role playing where the audience is encouraged to yell “STOP” and take the place of somebody in the play. I explained to them the scenarios that young Americans had developed, but most of them were not appropriate because of their open discussion of sexuality with their use, so they were encouraged to come up with their own scenarios that would be more appropriate for Sudanese youth. Here are 2 of the scenarios that they came up with:

Tea sellers, who often go for sex with customers on the streets and this one involved University boys buying tea, walking off with the tea seller, while their friends debated whether that was a smart thing to do – both from the viewpoint of the holy Koran, which prohibits sex before marriage, and from the danger of possible AIDS.

The second scenario involved a father who had misplaced his glasses. He comes into the sitting room and finds a packet on the table. Because he can’t see, he mistakes the small package of ketchup with a condom package. He was furious that his son would have brought this home to the house. As he yells at his son on why it’s in the house, his son doesn’t understand his father’s confusion and says, “Dad, we always have them on the table. It makes the food taste better.” The father becomes angrier when he hears his son talk about condoms in this way. This was a very funny scenario and introduced the idea of how young Sudanese are becoming more comfortable with having condoms.

I think that Stop Action Theater will also be a continuing part of the AIDS efforts in Sudan. Theater is always a wonderful way to engage people.

We ended up our visit to Sudan with a dinner with Ministry of Youth people and the different organizations that helped sponsor my walk in their country. I talked about what I had observed in their country. Based on another large meeting at the medical school of UMST I gave them my opinion that it was clear that Sudanese youth were very respectful of Islam and wanted to follow the teachings of the Koran. However, it was also clear that globalization was changing young ideas of their country and it was doing so rapidly. At first contact, almost every young person said that they didn’t have sex before marriage and wouldn’t consider it, but in follow up conversations it was apparent that even the most religious of youth acknowledged that either they or their friends were experimenting with sex. From some of the young women, we discovered that those that wore the traditional Muslim clothes that covered everything but just their eyes were sometimes more liberated in their thinking and behaviors than their counterparts that dressed more in Western styles. The young women who dressed American style (but everyone covers their hair) complained that some of these more pious looking women, were wearing this more conservative looking garb to fool their parents. I had observed this same phenomenon in Jordan. I have been invited back to Sudan in February for a major international conference on youth and AIDS, with the opportunity to travel throughout the country, but I will not be able to do it.

We have left behind so many wonderful people that whenever somebody mentions Sudan to me in a negative light due to the politics of their government, I will explain that my firsthand impression of the people themselves is radically different.

Friday, November 21, 2008

Darfur Refugees

Yesterday we visited a large refugee camp an hour outside of Khartoum. Up until a few years ago, it was nothing but tents filled with people who were escaping the violence in the Southern area of Darfur. However, today there are simple mud houses for 24,000 people. It is a monochromatic scene. There are no green trees; there is no blue water; there is only dust, sand, and brown squat buildings.

We were told that we were going to meet with youth at a local mosque, but this isn’t a mosque with a large dome and a minaret tower. It was a one room meeting hall with half of the roof open to the sky. When we got there two old men greeted us. Sitting inside were about 10 women with babies. Outside children were playing soccer. I was very surprised that there were no teenagers or young adults to be seen, but I was told that this village lacked any kind of AIDS education. Even the few people there would benefit from my information.

I started off with the introductions and why we were there in their camp. I also asked them to tell me where they came from. Most often I heard the word Darfur. I also asked them if they missed their homeland. I was surprised when many of them said, “No – we don’t think about it at all”. I turned to one of my young translators, Amira, and asked her how much I should talk about sex as a transmission route for HIV in a mixed audience in a Mosque. It wasn’t that I was shy, rather I didn’t want to cause problems in a mixed audience. She told me that it was okay to talk, and that people needed to hear the truth about HIV.

A discussion followed, including comments and questions from the group. I was pleasantly surprised that more and more people were arriving. Soon the inside of the mosque was full and people were leaning in through the open windows to hear what was being said. I estimate that there must have been 60 people hearing the AIDS prevention message. I stressed the fact that they needed to personally reach out to the thousands of other people in their refugee community, that lives could be saved if the conversation was started in every hut that AIDS was coming and would kill many innocent people. I specifically told the women that they must talk to their female friends, because otherwise they might see many burials of their children and teens in the future.

In the course of an hour, there was a lot of dialogue going on about this AIDS disease and questions were asked about what could be done. I told them to get a hold of the doctor, who was training 20 peer educators at a nearby clinic. I asked the doctor if he would be willing to train some of the young people from the camp, so they could go back to their families and neighbors to spread the word. He readily agreed. By this time, there was a convivial sense of real camaraderie. I asked if they would sing some songs. Two teenage boys were singled out as singers, but one boy looked absolutely embarrassed and quickly moved to the back of the room. Two other boys joined the one singer and sang a song about love. Then a religious teacher stood up and lead the group in a couple religious songs. So I decided that I could sing too. I explained that the song I would sing was a negro spiritual called “Swing Low, Sweet Chariot” and explained that slaves sang this song requesting that God send his angels and chariot down to pick them up when it was time to go to heaven.

The group broke up into animated conversation, but there was a loud incessant beeping of a car horn. It was Artif, our driver, who had other appointments to keep. Filled overflowing with 10 of us, in a UN donated car, we took off at harrowing speed back to Khartoum. I was actually very nervous and worried. I made it clear to the driver that I was not happy with the driving.

I thought this was the highlight of my day. However, when we got back to the international hostel where we were staying, Jimmy went off with the men in our group for a tour of Khartoum at night. The highlight of his night was stopping by a Sudanese wedding. He found it a very interesting cultural experience and much different than an American wedding. However, I made plans with Jaile to do AIDS attacks on the streets populated by young people. I had some most interesting conversation.

We walked through a darkened garden at the side of the road, filled with a mixed population relaxing in the balmy evening air. We met many young teenage boys who did not know much about AIDS but listened to the message while reading the business cards that we passed out. As we walked over to some tennis courts, Jaile saw a friend he knew from university. I introduced myself to the young man and for the next 35 minutes I learned a lot about the pressures of being a young Muslim man in a conservative culture. One of the boys went to school at UMST where I will be speaking tomorrow. As we walked over to get some Coca-Colas, one of the young men came up to me and asked me, “Dr. John I want to ask you something privately”.

Frankly, I was surprised by his question although, I am asked this question in many other countries and communities. This is the question he asked, “What about oral sex? Can you get HIV/AIDS from that?” I explained that it was not as high risk as vaginal or anal sex and there are few cases reported of people getting HIV orally. I said, “Are some of your friends having oral sex?” He said yes, but it was not common. He still kept asking more questions about HIV and oral sex. Soon I realized he was concerned about his own behaviors (earlier in the conversation with his group of friends that he didn’t have sex because of the Koran). I asked him to explain why he was worried. He said that he went to the women on the streets and paid money for this. He said that it had happened 5 times, but by the end of the conversation 10 minutes later it was clear that he was doing it 3-4 times a week over many months. He said to me, “What can I do to stop this?” and I told him that it was something for him to decide. I said to him that if he felt guilty about it, he should probably stop.

So even in the most conservative muslim culture, sex is present. We stayed talking to other groups of young men until midnight and many of their questions were on specific sexual acts that they had seen on the internet and rented DVDs. The adults that I had been meeting with this week in Sudan, would usually say that their young people are not having sex before marriage but like young people anywhere, they keep their sexual behaviors private. For whatever reason, young people feel more open to talk to me about their issues, perhaps because they see me as non-judgmental and willing to tell them the medical facts without censorship.

Thursday, November 20, 2008

Rousing Receptions at Sudanese Universities

Because of the on-going civil strife in Sudan with the accusations of genocide and the political mess over Dafur, the U.S. and Sudanese governments are adversaries. As an American, I must obtain a special visa to enter. The current situation severely complicated getting the necessary letters of invitation from government ministries or bona fide organizations aligned with them.

They always want to know what it is that I plan to do. I have found that I cannot be 100% forthright. If I say that I want to walk the streets, do “AIDS Attacks” and engage their youth in uncensored conversations -- that is a major red flag and sure to be denied. Soooo – I volunteer my time and expertise to official agencies in exchange for them arranging the invitation, getting the visa out of the Ministry of the Interior and cutting through the interminable bureaucratic red tape. That is what I did to gain permission to enter Sudan.

I hate long, boring meetings in offices – and waiting for meetings to happen. I love being with young people talking about what I know best. This dichotomy is always present when I travel on my global walks.

But enough complaining. After a few wasted hours doing what I detest, I will be off soon to do what I am excellent at. Frankly, I don’t believe there is any other AIDS prevention expert in the world today that has had as much one-on-one contact with youth at the most grassroots level – over 300,000 young people in 81 countries. I know what I am talking about although I learn more every day from interacting with teens and young adults.

On my itinerary today, we are scheduled for three hours of office meetings before I visit a major refugee camp outside of Khartoum, do a radio interview, and talk with youth at basketball courts and soccer fields. I will figure out a way to cut the scheduled office meetings in half with Jimmy’s help. And tonight, if everything goes to plan (and you will be the first to know), I will be talking with young people in undisclosed settings about what really goes on in youth culture underneath the watchful eyes of a strict Muslim society.

Yesterday I spoke to 900 students gathered for a three-hour, voluntary convocation on HIV/AIDS at Al Nileen University. It was amazing that so many students filled the auditorium beginning at mid-day. It was scheduled to start at 11 am but here in Sudan, as in many parts of the world, time is a relative thing. When we arrived in our UN land rover, students had been patiently waiting and listening to music from three singers/comedians. After a verse from the Koran, I was introduced. Without wasting any time, I began my talk with the abridged story of my friend Marlena. I use personal stories to illustrate the consequences of HIV. There was a hush in the assembled crowd as I explained her struggle. A cameraman captured the tears in some eyes and the loud laughter at points. The way to reach youth is through their emotions and I know how to do that.

About 85 minutes later (translation into Arabic takes time), there was rousing applause as I finished with admonitions to take personal responsibility for behavioral choices if they want the best life. By talking about their future babies, I emphasize that mistakes today will lead to children born with HIV/AIDS. For even hardened young males, this pitch gets their attention.

As the music began again, I left the stage and was mobbed by youth. I always ask their names and show them I am interested in knowing who they are. Slowly, I made my way up 36 crowded rows of students shaking their hands and signing autographs (hey, what the heck). The higher I got, the hotter it became and as I descended, I went out a fire escape for fresh air. Some students came out and asked questions. I always look them in the eyes and say “It is your responsibility now to tell your friends and younger brothers (or sisters, if females) about AIDS before it is too late” while grasping their hands to emphasize the point. You can tell how empowered they are.

From there, I excused myself and with a 23-year old volunteer from AEDAS (one of my official sponsors) we took off for the banks of the Nile where boys go swimming in the 100 degree heat. As the land rover cut through the brush on uneven dirt paths, we came across young males swimming in the clouded water (but relatively unpolluted). At first, they stared in bewilderment. I cut quite the figure with my short and round stature, white hair and loud Hawaiian shirt.

Jaile gathered them around as I introduced myself in broken Arabic. I soon discovered that my “overseas” English (I speak very slowly and choose simple words) was enough and only some translation was needed. They ranged in age from 18 to 23 and all but a few were University students. We conversed for twenty-five minutes giving them the opportunity to ask uncensored questions. The common complaint was that they would like to have sex but it was nearly impossible in Sudanese culture to arrange liaisons with female counterparts. At least half said the Koran forbid it but others admitted that their friends were doing it. They also said that looking at pornography on the internet and DVDs was not unusual.

The last activity of the day was serendipitous. A scheduled youth rally at an outdoor theater was abruptly cancelled due to the death of a well-known national singer. But Dr. Samah of SNAP (another official host) decided to call a nearby residence hall for university women. What a treat! They were already gathered for an evening concert that was underway when we arrived.

Speaking to 450 females dressed in their fashionable clothes from top to bottom, I told the story of my volunteer Sayeeda from the outskirts of Mumbai (formerly Bombay) in India. She was a very poor Muslim woman of twenty living in a Hindu society. And she had AIDS as did her two youngest. Carefully, I weaved the story of how twelve year old Sayeeda was betrothed to a young man she met on her wedding day. She had never been with any other man and they had three children when I first heard about Sayeeda. In the major Mumbai newspaper was a story of a young HIV-positive widow who was turned down for treatment at a hospital. This was in 2000 and India was not yet up to speed on AIDS awareness.

I hit all the key points always mixing humor with pathos to make the strongest impact. Many in the audience cried when I got to the part of her death and that of two of her children. I make sure that I compliment the students in attendance by saying “I know you are good women. I know you want your babies to be safe and healthy. Now go out and tell your friends about AIDS and save their lives,”

Afterwards, ten of us went out for a late night dinner of Sudanese specialties. I wasn’t really hungry and had to explain that my lack of appetite was due to the heat and my exhaustion of a full day. I finally had a nice night’s sleep. Today will be another great day!

Wednesday, November 19, 2008

Meeting the Youth of Africa

As I write this, the capitol city of Khartoum, Sudan is asleep. It is about 4:30 am and I can’t sleep. There is no light yet. A small dog in the distance is yelping in pain and a car has just sped by the international youth hostel where we are staying. In a few hours, the official car will come and pick me up for the start of trainings at SNAP – the Sudanese National AIDS Control Programme. I will be demonstrating the techniques I have developed over the years on the most effective ways to reach youth. I believe that Sudan is going to be a most interesting stop on my Africa trip…

We arrived yesterday evening from Nairobi. Kenya is Obama country – literally. Because his father was born there, every Kenyan has taken immense pride in his election as President of the United States. Can you imagine living in a poor, developing nation that has never been shown much attention or respect by the world’s super power but now one of your own has ascended to the most powerful position on earth?

Obama signs are posted across the city. Even at Nyumbani, the AIDS Orphanage run by the Catholic Church, posters are prominently displayed at their front entrance. There’s no mention of his liberal position on abortion – just his smiling countenance gazing at every visitor. I last visited Nyumbani in 2000. As a delegate at that year’s International AIDS Conference in Durban, South Africa where I was fortunate to be introduced to Nelson Mandela, I met Father D’Agostino, head of Nyumbani. He invited me to work in Kenya because he understood that youth were sorely in need of targeted prevention information and thought my street approach could work well.

Although the Church doesn’t agree with some of my prevention advice, especially the use of condoms as one way to avoid the transmission of HIV, I have been struck by the number of priests who have given me permission to talk to their parish youth yet would not be present when I did. That happened again yesterday.

Father D’Agostino passed away two years ago. He has been succeeded by Sister Mary Owen, a stern-faced Irish nun with a gentle manner and love for the children. We had met briefly before when I had a problem over stolen money and she knew my work. She said that she would bring me around to meet the teens living at the orphanage but with the proviso that she was not going to introduce me as a professional in the field.

We talked about Denis Buluma, an HIV-positive teen I had met in 2000. He had been one of my best outreach workers in downtown Nairobi. Denis is now living on his own and working at the airport. She told me he is excited to see me again and I hope it will happen the next time I pass through Nairobi to Rwanda. As we walked around the compound, I met other youth who recognized “Dr. John.” A shy young girl of 18 named Purity said she remembered me and she walked with us down to the little cemetery where I saw four crosses with the names of children I had met with the year 2000 inscribed. We often forget that with all of the medicines available in developed countries, many HIV-positive youth in most of the world have few resources to save them from advancing AIDS.

A tall worker came up to me with a big smile and said, “Dr. John, I thought that was you!” Wow! It was one of the young high school students from the high school run by the Don Bosco Order. We talked, exchanged emails and he told me how much he liked doing our “AIDS Attacks.” A teacher by the name of Noelix came to greet me and she reminded me of the mysterious gas fire that happened in my room when Agnes Chebor was beginning to cook us a meal. I’ll save that story for my book.

By this time, I was concerned about another appointment that we had with youth in the slum of Dandora. Traffic in Nairobi is notoriously congested and we were warned that it could take two hours jeopardizing our tight schedule to get to the airport. We went back to the car and asked Thomas if Maximilla Okello had shown up. Just then, George Kamau came up and said hello followed by Maximilla. He had been an employee at Nyumbani when I stayed there for two weeks.

But it was Maximilla who was the star attraction! We had met when she was volunteering at the orphanage. About three years ago, out of the blue, I got an email from her in Tanzania where she was teaching AIDS awareness off the TeenAIDS’ website. Maximilla had become proficient at using theater as a teaching tool. She sent me one of her plays that the teens put on. The storyline revolved around the appearance of AIDS (as a person) showing up at the door of a mother in a one-room hut. AIDS was there to take the woman’s children but she protested and wanted to know how she could prevent this from happening. It was a simple but ingenious metaphor.

Maximilla said that we wouldn’t have enough time to make it to Dandora and instead we were going to do a staff training at Mater Hospital. On the way over, she talked about her life, the election violence of last year and her little boy. It was a highlight for me to meet her again and everyone else at Nyumbani.

We made it to the airport in time. Jimmy got on the internet and sent off emails confirming our appointments in Rwanda next week and in the Congo after that. In both countries we will be traveling into the interiors. In Rwanda, we are setting up a meeting with children of the genocide that killed 800,000 Tutsi minority in one month’s time in 1994. In the Congo, we will travel far up the Congo river and meet youth in remote villages including the infamous boy soldiers.

Jimmy is very excited about this unfolding experience and has helped tremendously in organizing everything. He has just left for an early morning stroll. Our driver will be here soon and I want to take a shower first. Jimmy said the water was running very cold but here in the Sudan where the temperature is already in the low 90s, it will be a refreshing wake-up. By noon, it will be over 100 degrees.

We have met the nicest people last night who picked us up. Dr. Samah of SNAP and Ali of AEDAS and his staff took us to “Steers” to get a late night snack before dropping us off at the hostel. Our adventure continues.

Monday, November 17, 2008

In Africa Finally!!!!

Jimmy and I finally arrived in Nairobi, Kenya today. After a long wait at customs we were picked up by Lynne Elson, who serves on the Global Advisory Council and we are now at her house. Tomorrow morning we will go to Nyumbani AIDS orphanage, the AIDS orpahange that I had visited in 2000. We will be meeting with Sister Mary Owen and with some teenagers that live in the homes there. We are going to meet Maximilla Okello, who I met there before. Then we are heading to a youth meeting in the area of Dandora. Keeping our eyes on the time, we have to high tail it to the airport for our flight to Khartoum, Sudan.

It is interesting being in Obama's father's home country. Everyone here is very excited about his recent election, and they had a national holiday to celebrate. His father is a member of the Luo tribe. Some of you might remember the election violence that gripped Kenya for 4 months last year. The Luo tribe now is one of the 2 main tribes running the Kenyan government. We were told the government is building a special road to the Obama homestead with electricity and running water. Look forward to the next posting from Khartoum, Sudan!

Friday, November 14, 2008

Twisting the nite away

It's been a string of late nights now -- and only two days to go before I get to Africa, a beautiful and complex continent. Some people say they are scared of going there but I think they are missing the excitement of different countries and peoples in transition. Last night we had a rousing send-off for Jimmy Kircher and me at the swank Cafe Destare in Fitchburg. Ranging in age from 16 to 91, the crowd expressed their wishes for a safe and successful experience. But wait! What else would we expect them to say -- "Break a leg, Dr. John!"? Yet, in a sense, walking the streets of the world promoting HIV prevention is a bit of serious street theater. Which brings me to the news that we will be introducing "Stop Action Theater" in remote villages and city neighborhoods.

The nicest thing about this work with teens is most all of them really appreciate the news. A simple "thanks for everything," says it all. The older I get, the less I like to hear applause. After all, it is us trainers that reap the rewards of seeing lives saved from bad decisions. However, something really nice happened tonight. I got a call from Langley, Washington, a place I was sure that I knew no one. Her name was Betsy MacGregor and she is a retired medical doctor. Recently in Kampala, Uganda, Betsy ran into our trusted PeerCorps coordinator, Derrick Tebizinda. I met Derrick at his high school about 8 years ago -- he became our Uganda chief. But I lost touch with him about two years ago. Derrick told Betsy about his work with TeenAIDS and she called me out of the blue. She emailed Derrick:

"Hi again Derrick -- I just called Dr. John and had a wonderful conversation with him! I told him about meeting you, and he was very happy to hear that we had met, and he sends his greetings and love. I told him a little about your orphanage and how Charles and I are giving you some help with the kids there. He said he is leaving in three days for another Africa Walk to the Congo, Sudan, Kenya, etc.

"Dr John is certainly a hard-working and dedicated person! I'm so glad that you have had the opportunity to learn from him and work with him. Through people like him we can see how the world is slowly but steadily learning the truth: that we are all one family -- the human family. We are learning how to reach around the world and care for each other, and that is very hopeful! Blessings to you, Betsy"

Thank you Derrick and Betsy annd everyone who is sending their best wishes. I will pass them on to the youth we meet,

Put my dog Jazz in your best thoughts as we are constant companions and I am having to leave him at a time that he is ill. I'll post a photo of John's best friend soon.

Business interns Joe Wasuk and Dusty Burdette will hold the fort down until I get back. Dusty has been appointed Assistant Office Manager in my absence. Of course, as always, Johanne Cimon provides a honed level of organization, professionalism and maturity to the youthful operations.

Volunteers and Communication majors at Fitchburg State College, Erik Weikert and Peter Keto are co-producers of this year's global webcast from the Congo. Photographer Megan Benevides is exhibiting her photos. You can watch video from Africa Walk and global youth and text message to Dr. John with your questions. We will have African youth answer your questions too. I am so glad that Jimmy Kircher is coming as my assistant to run the production from Kinshasa. Can you imagine what this experience will mean to them professionally in the future? We thank George Stemper of Onstream Media fot the company's major assistance on the third joint venture between TeenAIDS and Onstream. They are sending the signal to computers worldwide. You can take part on December 1, World AIDS Day by going to the front page of this website and clicking on the webcast button. But wait a few more days...

I also want to thank the crew at Newman Communications in Brighton, Mass. for coordinating the large number of radio and TV interviews with me. They are true professionals at their PR trade.

Special thanks to Haley Dean and Megan Gazda.

Tuesday, November 11, 2008

Cure for AIDS?

For most all professionals that accept that HIV is the cause for AIDS, little hope has existed that a cure would soon be found. After multi-millions of dollars and thousands of scientists working on AIDS research for 25 years, we have treatments but no cure. We don’t have a vaccine for HIV. Now comes a startling headline in Friday's Wall Street Journal: “A Doctor, a Mutation and a Potential Cure for AIDS.” The story tells the story of a man who appears to have been "functionally cured" of AIDS. He is off all anti-HIV meds, has a normal T-cell count, and exhibits no evidence of virus.

Top AIDS experts are intrigued that something important might be happening. The highly respected foundation “amfAR” (of Dr. Mathilde Krim and celebrity sponsor Elizabeth Taylor fame) decided that there is a possibility of finding a cure at last. Their senior scientific consultant Dr. Jeffrey Laurence has prepared a brief, easy-to-understand summary of the case that you can read by going to:

http://www.amfar.org/cgi-bin/iowa/programs/resrch/record.html?record=71

If this single case can be replicated, it could be the wish come true of every person helping to stop the spread of HIV. In my travels, I have come across firsthand stories of homemade cures. I have seen jars filled with jelly-like things floating in milky looking fluids above a slimy bed of something like deformed seaweed. Desperate people will buy any hope – even a charlatan’s cure.

It is sad to think of all those who will die before the cure is discovered.

Monday, November 10, 2008

Six Days

Six more days before we leave for the Heart of Africa AIDS Prevention
Walk. Two more days before Jimmy Kircher arrives from Dartmouth
College to be trained and assigned trip tasks. Having Jimmy on board
is unique because I have never travelled with a volunteer for more
than a week. He is keeping track of expenses, acting as an advance
man, helping with the video postings to You Tube and our website and
most importantly, being an effective trainer.

Twenty more days to the Third Annual Global Webcast for Teens. We
are scrambling to keep our plans operational -- but the political
situation in the Congo is complicating the technical plans and
official permissions. However, the excitement is in producing a live
webcast despite the challenges. Stay tuned for December 1.

It has been four days since emails began coming in from former
PeerCorps and TeenAIDS' supporters celebrating the election of Barack
Obama. As someone who has travelled extensively off the
tourist/resort path, I had noticed the deteriorating image of America
in most foreign lands. Judging by the recent emails, I am guessing
that I will see a positive difference in African attitudes towards
the USA now. The irony: Bush has spent more money in Africa on AIDS
than any other President. But his Administration's
abstinence-only-until-marriage funding restrictions have prevented
innocent lives from being saved.

I decided to reprint the French cards. Tomorrow and the next day, I
am concentrating on scheduling for my "AIDS Attacks" in Rwanda and
Congo. Also, planning our Wednesday evening event that is both my
send-off and a kick-off for the February 27th Gala at the Fay Club.
Maybe you can contribute auction items like sports memorabilia,
artwork or unique items. The office will be running while I am away.
You can leave messages for me or for Dusty, Johanne or Joe. We are
renting a satellite phone but with the expensive airtime, it's best
if you email me: chittick@post.harvard.edu

Who has a car in good working order that can be donated and can carry
me and three or four volunteers and supplies?

Saturday, November 8, 2008

Let 'em die!

The response by some adults is one of complete indifference to the
threat of HIV targeting teens. This is most bizarre because no doubt
exists among experts that AIDS is becoming a more youth-oriented
pandemic. With half of all new cases of HIV in the world occurring
among 12-24 years olds (UNAIDS, Geneva), this emerging trend is
serious, deadly serious. But just like with the original high risk
groups from the '80s, a number of people brush off deaths from AIDS
as a fit punishment for high-risk behaviors by bad people.

"Let 'em die" was heard in the early years of the US epidemic. We
had a President who didn't utter the word "AIDS" until well into the
crisis near the end of his second term. Thank God, for his US
Surgeon General (C. Everett Koop, M.D.) talking about the elephant in
the room. Many people have forgotten that Koop authorized the first
and only mass mailing about AIDS to EVERY US household. Talk about
controversy!

So here we are in 2008, almost 30 years into the AIDS catastrophe and
some adults, government officials, schools and parents are dismissing
the very idea that HIV is a real threat that is spreading faster
among sexually active teens. "Not my child!." I have heard. "If
they're going to screw around, they deserve it." No one deserves to
get HIV because of a mistake in judgement or from ignorance. After
all, we require teens to go to Driver's Ed before getting a license
to drive a car on the streets. Schools did a better job of HIV/AIDS
education twenty years ago than they are doing now. It's a disgrace.
As concerned citizens, we should all be troubled by the huge cost of
a larger HIV epidemic and growing numbers of AIDS deaths globally.
Even if one believes that teens and young adults should not be having
pre-marital sex, should they die for those behaviors that are widely
promoted on the airwaves and the internet? At what age, do we start
educating children about the biological facts to stop the spread of
HIV (reputable research shows 15% of pre-teens are now experimenting
before age 13)?

I say, "Let 'em live!"

Friday, November 7, 2008

Africa or Bust

Why are we travelling to dangerous areas in Africa to spread the news about AIDS prevention? I hear this a lot. I just got off the phone with a person who expressed her concern. I realize that it is difficult for some people to realize that ordinary teens are very much at risk for HIV/AIDS -- and too many governments have failed to address the situation adequately. If we don't reach out -- who will?

Our send-off is taking place on Wednesday, November 12th at Cafe Destare in Fitchburg. Chris, Paul and Lance, the owners, have been generous supporters. I will meet with the press and TV cameras at Logan Airport on Sunday, November 16.

Our visas are in for Sudan and Democratic Republic of Congo but have cost almost $1,000 for the two of us. Rwanda and Kenya do not require Americans to have visas. We have a very exacting schedule while in Sudan that will take us to refugee camps, schools, sports fields and markets. I have ourArabic-language cards ready to go. I realize that our French language cards were printed with our old Boston address, and while most teens correspond with us by email, I am thinking I should spend the money to re-print. But then on the other hand, every penny counts and since there is never enough money to pay me anything like a living wage, maybe penny pinching is a good idea.

If you read the Boston Globe article you will discover that the Bank foreclosed on my house and TeenAIDS' offices. It was scheduled to be boarded up while I was away in Africa with the loss of most of everything inside because there was no money to pack, move or store my possessions or the TeenAIDS' office. Fortunately, some good people helped rescue me. Kids, I love what I do but think twice before you devote yourselves to charitable work.

Jimmy Kircher has done a great job fund raising -- he's now up to $3,000. Dartmouth College students have chipped in as well as past brothers of his fraternity Phi Delt. He will come to the office five days before we leave so he can help with our last minute plans and be trained. I think he will be a great addition. This is the first time in 10 years of solo Walks that I am taking along an assistant trainer.

Tuesday, November 4, 2008

Disturbing Trends

For many adults, the issue of AIDS is off their radar. That's very bad news for their teenage children, nephews and nieces or young friends. Let me tell you about the incredibly stupid advice one medical doctor recently gave a college student in my hometown.

A young 21 year old called me that he feared he might have gotten AIDS after noticing tiny spots on his penis following unprotected sex with a girl. I told him to visit his family doctor for a check up and added it most likely wasn't HIV/AIDS but a STD. I also urged him to use a condom every time because protection is always safer than not using condoms. I assumed the doctor would warn him too. BUT NO! The student told me that the doctor said it was probably HPV but because he was "a good kid from a good family" -- he wouldn't get AIDS, there was nothing to worry about. I was astounded at the advice the young man received and emailed the doctor that he has an obligation to explain the consequences of unprotected sex to all his young patients. Coming from a "good family" is no protection in this day and age.

We know that one out of four new cases of HIV in the USA occurs among teens (CDC, 2008). When I started in this business, that number was less than 5% -- most of it from bad blood and/or mother-to-child transfusions. Now, it is mostly the result of sexual transmission. And all teens are beginning sex at earlier ages than their parents' generation. THEN...

Buried in the late night news two weeks ago was a short story about a high school in St. Louis, Missouri with an AIDS scare. One student tested positive for HIV and 50 students were identified as possibly being at risk. What does that say about liaisons today? However, an
adult appeared and said no one should be overly concerned because that was only fifty kids that needed to be tested out of a student population of 1,600. Hello????? Now you understand why I feel compelled to devote my life to educating youth.

Sunday, November 2, 2008

First stop: Sudan

Our first destination is Sudan. We are working in conjunction with three organizations, the official SNAP, AEDAS and UMST (the university). We will work and train in Khartoum and in outside areas. I am pleased that these groups are planning our schedule and complimentary accommodations. You have to have invitations to get a government-approved visa to the country. We all hear about Dafur and while I don't know if Jimmy and I will go there, youth in refugee camps need HIV education too. We will reach out to every teen through a widespread PeerCorps network. This well-tested model relies on empowering teen volunteers with the faith they can be effective peer teachers. I have enjoyed working with both Christian and Muslim students who are curious to hear our message. "You now have the power to save your best friends' lives," I say. Our Arabic language cards are printed.

If it wasn't for one of our longest-serving Board members, it would be really difficult to pay for our Walk. Jim D. bought us free air tickets to Africa and inter-regional flights too. Jimmy has been busy raising funds at Dartmouth and among his friends. There is still time to make a tax-deductible pledge through PayPal or mail.

Hopefully, the new U.S. President will bring more enlightened policies to HIV/AIDS prevention efforts for teens. Wherever I walk, youth appreciate an American citizen who comes to their community to share life-saving information. They have the human right to hear all the medically-information. No censorship of biological facts!

Congo Rebels and AIDS Advance

Congo (DRC) one of the countries that we are visiting is experiencing renewed rebel advances in its eastern region near the western area of Rwanda, where Jimmy Kircher and I will also be training teens. We will avoid the fighting but will be going into the interior regions including up the Congo River. Wherever there is civil strife, teens are especially at risk when they are not getting HIV prevention news because their schools are closed. Violence breeds AIDS, unfortunately. If you have seen the film, "Blood Diamonds," you know we have our work cut out for ourselves.

Another hassle is the repeated bad luck we have had with our internet server: webhost4life. Operating out of California originally, it has now shifted its operations to Asia. There have been tremendous technical problems causing the disastrous interruption of our internet and email messages. Trying to get the attention of supervisors with responsibility has been nearly impossible. As I write this, we are down again with only two weeks to go before we leave. I will try to find the money to switch to a more dependable outfit after I come back. Caveat emptor...

With very limited funds, much less than I anticipated we would raise, we leave on November 16. The massive economic collapse has hindered giving. Soooo --- can you spare some cash?