While the disease is still active in the U.S., increases are occurring in central and eastern Europe, and in parts of west, central and south Asia.

For more, Daljit Dhaliwal interviews Martin Blaser, past president of the Infectious Diseases Society of America and the current chairman of the Department of Medicine at the Medical School of New York University.

However, how quickly you get treated actually depends on what disease you have and how likely you are to be cured.

Watch the interview with Victor Rodwin about the intricacies of the health care system in Chile and how it compares to the United States.

For more Worldfocus coverage of the Chilean Economy, click here.

Rodwin explains how a health care system that targets only diseases that are widespread and treatable can make sense. He also talks about the fact that the United States has a similar system in place, although much more limited.

Watch the Worldfocus signature story: Chilean law fast-tracks treatment for common illnesses.

Gloria, who is HIV positive, in Khayelitsha township outside Cape Town where the Treatment Action Campaign (TAC) is holding an AIDS awareness campaign. South Africa. Photo: Trevor Samson / World Bank

Ayo Johnson is a contributing blogger for Worldfocus. His full post on HIV in Africa can be found here at his blog Africa Speak International.
The World Health Organization (WHO) and United Nations programme on AIDS (UNAIDS) estimate that there are currently 33 million people in the world living with HIV. There are an estimated 24 million people living with the disease in Sub-Saharan Africa, and 61% of those infected are women. In South Africa and Zimbabwe 75% of young people infected are girls between the ages 15-24.

Factors that have contributed to HIV increase are cultural taboos and gender inequality. It is difficult for women to choose their sexual partners, how often they are intimate, or to demand the use of condoms. Women are also more vulnerable than men due to the prevalence of underage sex, early marriage, polygamous relationships and female circumcisions.

In South Africa, rape and drug dependency make women vulnerable to sexual exploitation and infection. In Sierra Leone, it is common practice for so-called “sugar daddies” to offer schoolgirls material goods and cash in return for sexual favours, often exposing them to the disease. This can happen with the consent of older family members who are powerless to act due to poverty and ignorance.

UNAIDS urges governments to get the right laws and policies in place to ensure women are educated and empowered — for example the ability to keep land, homes and assets when their husband dies.
Governments need to reverse policies on gender inequality, forge closer relationship with NGO’s and private entities, and encourage community-based support groups, clean drinking water and good nutritional food. Failure to provide these basic human requirements risk women becoming an endangered species and endangering the fate of human race.

Correspondent Lynn Sherr and producer Megan Thompson examine how the modern lifestyle of long work hours and abundant fast food have eroded traditional Greek eating habits — and how some Greeks now are fighting back to reclaim their “slow food” heritage.

Get recipes and see Nikos and Lola Frantzeskakis cook up some healthy — and delicious — dishes in Vamos, Crete.

They visit “slow food” advocates Nikos and Lola Frantzeskakis to learn how to cook up healthy — and delicious — dishes in Vamos, Crete using locally-grown vegetables, meats, and of course, lots of olive oil.

RECIPES:

Zucchini with Eggs

1 pound zucchini cut in 1″ slices
1 cup olive oil
1 cup onions, chopped
3 fresh tomatoes, chopped
1 cup water
Salt and pepper, to taste
4 eggs

1. Ιn a pot combine zucchini, oil, onions, tomatoes, and 1 cup water.

2. Cook οn a low boil for about 25 minutes.

3. Beat the eggs and add to pot. Salt and pepper to taste.

4. Let cook for 10 more minutes.

Serves 4.

Okra with Chicken

1 pound okra (fresh or frozen)
1 pound chicken breast
1 onion, chopped
1 cup of olive oil
3 fresh tomatoes, chopped or 2 cups canned tomatoes
1 1/2 cups water
Sa/t and pepper, to taste
Vinegar

1. Prepare fresh okra by washing and draining well. Remove the stems.
2. Spread the okra in a pan and sprinkle with vinegar. Set the pan in the sun for 30 mins to an hour.
3. In a large pot, cook the okra in the olive oil, vinegar, and salt for about 10 minutes.
4. Remove the okra from the pot.
5. Add the chicken to the pot and sauté with onion and more oil [if needed] for 5 minutes.
3. Add tomatoes, cook for 5 minutes.
4. Add water, okra, salt and pepper. Cook on a low boil for 20 minutes. Add more water if needed. Salt and pepper, to taste.

Serves 6

Henry Aaron, a senior fellow and noted health care expert with the Brookings Institution in Washington DC, joins Martin Savidge to discuss the issue.

Tell Us What You Think:

In an effort to bring down healthcare costs, should the U.S. government limit payment for cancer-fighting drugs that only extend life by a few months?

Please remember to be respectful and on-point in your comments. Malicious or offensive comments will be deleted and repeat offenders will be banned.

Dr. Martin Blaser, the chair of the department of medicine at the New York University School of Medicine, joins Daljit Dhaliwal to discuss the latest developments in the H1N1 pandemic. He says that as many as 100 million Americans may become infected with the flu this season and explains why the United States has lagged in vaccination distribution.

A Mexico city statue during the early days of swine flu. Photo: Flickr user olivcris

With concerns rising in the U.S. and abroad about the H1N1 virus, we want to hear your thoughts.

Do you think the U.S. government is doing enough to protect American citizens from H1N1?

Tell us what you think in the comments section below. Please remember to be respectful and on-point in your comments. Malicious or offensive comments will be deleted and repeat offenders will be banned.

In conjunction with Magnum In Motion photographer Susan Meiselas, the human rights group produced a video/slideshow about a 25-year-old North Indian woman who died during childbirth.

Worldfocus spoke with Aruna Kashyap, the lead researcher of the in-depth study, “No Tally of the Anguish.”

Is the rate of maternal mortality still exceptionally high in India?

Kashyap: Yes. India is an emerging economic superpower known for its medical prowess. There are also large portions of money allocated for healthcare programs - including maternal healthcare programs - that go unspent annually. This context is very important when analyzing data on maternal mortality. If we look at the “BRIC” countries – India’s maternal mortality level is 16 times that of Russia, 10 times that of China, and 4 times that of Brazil. Also, about 1 in 70 girls who reach reproductive age in India will eventually die because of a pregnancy-related cause, compared to 1 in 7,300 in the developed world.

The latest all-India estimates show that there has been a small decline in maternal mortality since 1997. But maternal mortality measures are mere estimates. They are also presented as averages, and averages do not tell the actual story. For example, while all-India figures show a decline, Haryana and Punjab show an increase in maternal mortality. Critically, these estimates camouflage the huge disparities in access to healthcare, including maternal healthcare, between the rich and the poor. The question is whether the little progress that health authorities are making in reducing maternal mortality is percolating down to the marginalized and the poor. Many populations in India endure poor maternal health because of many levers of inequality, including those based on caste, residence, education and awareness, age, and number of children. For example, a 2007 UNICEF study showed that 60 percent of the maternal deaths documented in six northern Indian states occurred in Dalit and tribal communities.

Moreover, for every maternal death, around 20-30 women are left with injuries, diseases or infections after childbirth or unsafe abortions, many lasting a lifetime. A woman may survive childbirth but suffer obstetric fistula and ensure life-long humiliation and even abandonment if not treated. There is very little data on this, but health experts believe that maternal morbidity levels are also very high in India, which is a cause for concern.

What are the most successful government policies in reducing maternal mortality?

Kashyap: Globally, about 80 percent of all maternal deaths are said to be caused by direct obstetric causes—hemorrhage, obstructed labor, eclampsia, and unsafe abortions. Many years of research and evaluations of different health interventions have led public health experts to conclude that there are four key maternal mortality reducing strategies that address these direct obstetric causes–access to emergency obstetric care, good referral systems, skilled birth attendance, and reducing the number of unwanted pregnancies. Health authorities should also strengthen women’s access to safe abortions. The indirect causes of maternal mortality and morbidity are malaria, hepatitis, tuberculosis, and HIV. There have to be interventions to ensure that these indirect causes are also addressed.

In India, about 65 percent of all maternal deaths are caused by direct obstetric causes and 35 percent are caused by indirect causes. So for maximum impact, healthcare interventions have to address both.

To what extent do you blame village-level government officials for not doing enough?

Kashyap: It depends on what aspect we are looking at. For example, if we look at civil registration, there are village level officers who are supposed to register deaths which they are not doing. Where this is because the state has not appointed such officers the state is to blame, but otherwise, a part of the blame also lies with the village level authorities.

In the case of delivery of maternal healthcare services, at the village level, female health workers implement the maternal healthcare programs. Most of them have very little say in how programs are designed and implemented because the healthcare system is top-heavy. These workers should also be equipped with essential drugs, blood pressure measuring machines, weighing machines, gloves, and so on that they can use to check the health of pregnant women and conduct deliveries. If they are not equipped, then there is very little they can do. For example, we interacted with health workers who are charged with providing antenatal care but had not been given a blood pressure gadget for several years even though they had put in repeated requests to get such gadgets.

The decisions are made at the national, state, and district levels. So unless decision-makers at these different levels do not change policies and programs, health workers at the field level cannot be blamed. Be it caste-based discrimination or corruption at any level, the power to monitor and undertake corrective action largely lies with district and state health authorities.

There have been attempts to change this. The Indian government has tried to decentralize decision making under its flagship rural healthcare program, the National Rural Health Mission, 2005. Under this, the Indian government has provided for “untied funds” that can be managed by health workers along with local elected village council heads. But this has not been very effective for several reasons. Poor awareness regarding these provisions, a lack of initiative by elected village council heads, corruption, are some of the reasons. The Indian government has also created Patient Welfare Committees (Rogi Kalyan Samiti) to decentralize decision-making and management of the hospital. These committees also have grievance and redress powers. But once again, these are yet to be effectively utilized.

What is your outlook for realistic improvements in maternal mortality over the next two decades?

Kashyap: There has been little progress in the last decade not only in India but in many other countries. But since 2005, at least on paper, the Indian government guarantees a host of maternal healthcare services free of cost. In order to ensure that these are effectively implemented, the Indian government should monitor the implementation of these programs. This can be done in several ways: recording and investigating all maternal deaths to identify and rectify health system failures; monitoring whether women with pregnancy-related complications are actually getting access to maternal healthcare; setting up a grievance and redress protocol including emergency response systems like a telephone hotline that can be used by pregnant women in distress; paying attention to strengthening the public health system, including training health workers in midwifery.

If all of this is done, then perhaps India will be able to show more results not only in averages but also for the poor and the marginalized.

How has your experience with maternal mortality issues affected you personally?

Kashyap: I feel outraged by the injustice of these preventable deaths. There are some women’s faces and stories that come back to me often. For example, the mother-in-law who cried while describing how her pregnant daughter-in-law died in a community health center because she could not afford to take her a better health facility. She had just one lingering plea that it should not happen to anyone else. Then another woman who asked me why she would take 1400 rupees (the cash assistance given to rural women to deliver in health facilities) and go to a health facility to kill herself –- referring to the fact that many women are often turned away from such facilities without medical assistance because they are ill-equipped to handle pregnancy complications. I hope the government will read some of these stories and make their health system more accountable to these women.

- Ben Piven

Produced, Filmed, and Edited by Samuel Loewenberg

Samuel – off camera (Spanish): What is your name?

Little Girl: Domitila

Samuel – off camera: And how old are you?

Little Girl: Nine.

VO: Domitila is nine years old and she cannot smile. Her muscles are too weak. She is the face of hunger in Guatemala, which has one of the highest rates of malnutrition in the world.

Dr. Evelin Nufio, from the Bethania Infant Nutritional Recuperation Center in Chiquimula, Guatemala (Spanish): The children usually come with thin hair that falls out easily, their skin is pale, these children are without joy, and their faces have a look of sadness.

VO: Nearly half the children in Guatemala are malnourished and in some areas nearly every child is affected. Most don’t reach a state as severe as Domitila, where their body begins to waste away. Instead, they have a more insidious problem, known as chronic malnutrition, which means that while they are getting enough calories, the food they eat is severely lacking in vitamins and protein. The poor nutrition affects not only their height, but their future.

Dr. Juan Aguilar, the Guatemalan Secretary of Food Security and Nutrition:

We have concentrations of, prevalence of malnutrition, chronic malnutrition, in children as high as 90 percent in some municipalities. This is unbelievable. This is so dramatic that you can very easily get into the spirit that nothing can be done.

VO: More than 2 million Guatemalans live in extreme poverty, and officials warn that mounting economic pressures mean that many may not be able to feed themselves in the coming months.

VO: In some ways this is surprising: overall, Guatemala is not poor, and produces enough food. But most of the benefits only go to a privileged few.

VO: Guatemala is divided in two worlds, which rarely, if ever meet. On the one side are a small group of the very rich who own most of the land and control the economy. Their lives take place in sequestered neighborhoods, filled with shopping malls, fancy restaurants, and parties, all protected by the ubiquitous armed guards

VO: The other world is made up of large swathes of the very poor, more than half of population, most of whom are indigenous people working as subsistence farmers. They live in isolated villages without electricity, sewage, or clean water. Educational levels are among the worst in Latin America, and access to health care is negligible. Diarrhea and infections are rampant. Many of the poorest villages were at the center of the 30-year civil war, which only ended in 1996.

VO: Now, the mounting pressures from the global economic crisis and climate changes, health officials warn that hundreds of thousands of people may not be able to feed themselves

Dr. Evelin Nufio (Spanish):Yes, it is having an effect on the whole population on a general level. More so with people with low incomes because there are a lot of farms that do not have work anymore.

VO: Children are still getting food, but it is often just tortilla or pasta. Eggs and beans – which are high in protein – are a luxury, which may only come once or twice a week. Vitamin deficiency remains a constant problem, made worse by unsanitary conditions and dirty water.

VO: The result of chronic malnutrition is stunting - people do not grow as much as they should.

Claudia Nieves, nutrition expert with Save the Children USA: Children are stunted, which is they are shorter for their age than what the growth curves suggest they should be, and they are also low weight for height. So most of the children will probably be adults with no education and very low socioeconomic status.

VO: Long-term studies have recently shown that stunting adversely affects not only height, but brain development and future earning power.

Claudia: It is very difficult to make them understand that being short and being low weight is a health problem. Usually they believe it when kids start getting diarrhea, chronic diarrhea, and they are in and out of the health post everyday because of sickness, then they worry. But just on a normal day, they don’t really believe that it’s a problem.

VO: In the worst cases, like Sucely and Israel, the problems of hunger are painfully visible. But for most children suffering from chronic malnutrition, the symptoms are often hidden.

VO: Guatemala’s chronic malnutrition remains at a time when nearly every country in Latin America has significantly reduced the problem, even those that are much poorer.

While international donors, including the U.S., are providing emergency supplies, food alone is not enough to change the fundamental economic and socials problems at the root of Guatemala’s hidden malnutrition.

VO: Domitila was lucky, she had a foreign sponsor and so made it to the clinic. But her brothers and sisters do not. They are still waiting.

END TRANSCRIPT

There has been considerable progress toward eliminating this global health scourge. But the worms continue to spread through contaminated drinking water, and this is where Sudan is now fighting an eradication campaign.

Gary Strieker reports from southern Sudan, in association with the Global Health Frontline News Project.

Note: This story contains graphic images.

Political advertisements ahead of the parliamentary election in Greece.

ATHENS — On my trips overseas, I often find myself sizing up the country I happen to be visiting, and looking back by comparison at things going on at home.

Greece is in the final days before a Sunday parliamentary election, with the possibility that George Papandreou, the son and grandson of former prime ministers, may replace Kostas Karamanlis, nephew of a former prime minister.

I was chatting about the state of politics the other day with a Greek friend, and he was wondering out loud why his countrymen couldn’t find candidates besides those named Karamanlis and Papandreou, out of 12 million Greeks. “It’s a little bit like the Republicans and the Democrats,” said my friend, Kostas, trained as an economist. “I don’t think these guys would even be in politics at all if it weren’t for their famous last names.”

“Sounds familiar,” I said.

And the conversation turned to what was happening in the United States. I reminded Kostas that the big item on the table in Washington was the question of universal health care.

He just doesn’t get it. And neither do I. By sheer coincidence, the day after I arrived in Athens last week, I found myself taking my mother-in-law to the hospital at 4:00 a.m. after she’d fallen and sustained a cut on the side of her head. We arrived at the Hippocrates hospital clinic, about 10 minutes by car from our hotel, where we were able to communicate well enough with triage clerks and nurses. The wound was not serious, so they told us to have a seat and wait for a little while. The waiting room was modern, and we were given a number out of a series of priorities which were displayed on a large computer readout at one end of the room. “Don’t worry,” a nurse said. “It won’t take long.”

I saw people coming in with more serious injuries and a couple of older people that might have had heart attacks or similar ailments. They were brought in by efficient ambulances, and were quickly dispatched on gurneys to examination rooms.

My mother-in-law’s number came up after about 15 minutes, and she was ushered in. A friendly, Italian-trained doctor had a quick look, gave her two stitches and a tetanus shot, and told her to stop by his office for a checkup a few days later. “Oh, by the way,” he added, “let me write down your name.” He took notes on what he’d done and gave a copy to us.

That was it. We looked around, waiting, wondering, and the doctor smiled. We smiled. The nurses smiled.

“Nice to meet you,” they said.

What was missing from the picture? The hospital didn’t have an intake desk, didn’t have a pay window, and no billing procedures that we could see. It was free.

“Of course,” my friend Kostas said, “the vast majority of our hospitals are public hospitals. Maybe it’s not the best system in the world, but it’s quite efficient, and we’re happy.”

I told Kostas that a late night emergency room visit to a hospital back home probably –- ball park estimate -– would have cost $1,000.

“Why?” he asked.

“Well, a lot of Americans seem to think that universal health care is socialist. Americans don’t like the word socialist. And powerful people are fighting the idea of free health care.”

Kostas had generally heard of the issue, but couldn’t believe my description of the uninsured, of high insurance rates, and of people being kicked off the roles of insurance when they lose their jobs or get really sick.

“That wouldn’t be a campaign issue here,” Kostas said. Neither the present Prime Minister Kourmanlis, who belongs to a center-right political party, nor his possible successor, Papandreou, a center-left candidate, would ever question the right of citizens to receive quality health care from the government.

“It sounds crazy,” said Kostas.

- Peter Eisner

Photo courtesy of Flickr user ggia under a Creative Commons license.

Daljit Dhaliwal sits down with Julia Greenberg, the associate director of AIDS-Free World, a global advocacy group tackling HIV/AIDS. They place Jamaica’s AIDS epidemic within the context of the Caribbean region, address anti-sodomy laws in Jamaica and around the world and identify the successes and shortcomings Jamaica has experienced in containing the epidemic.

Daljit and Julia also look at the role women play in the epidemic. Women make up half of the adults living with the virus in the Caribbean, and are infected by “bridging populations” — bi-sexual men who are leading double lives. Julia raises the possibility of linking women’s rights with gay rights to tackle the spread of the epidemic.

• Watch all the Worldfocus In the Shadows video signature series
• Listen to Worldfocus Radio on LGBT politics and gay asylum
• For more information on homophobia and HIV in Jamaica, visit The Glass Closet, a multimedia project produced in partnership with the Pulitzer Center on Crisis Reporting

TRANSCRIPT:

Daljit Dhaliwal: Hello, I’m Daljit Dhaliwal of Worldfocus, and joining me now is Julia Greenberg. She is the associate director of AIDS-Free World, a global advocacy group tackling HIV and AIDS, and she responsible for the Caribbean region. Julia, thank you very much for joining us.

Julia Greenberg: I’m delighted to be here.

Daljit Dhaliwal: So, give us some background on AIDS and HIV in the Caribbean, especially in Jamaica. Start off with that. What are the rates of infection and what are the trends that we are seeing?

Julia Greenberg: Sure. I think the most important thing to know is that in the general population the HIV prevalence rate is 1.6 percent. But if you look at the population of men having sex with men — the gay community — that prevalence rate soars to 31.1 percent.

Daljit Dhaliwal: And what is being done about trying to reach out to these groups and to try and educate them about HIV and AIDS, and to come up with preventative measures?

Julia Greenberg: Well, I think you have to step back when you look at the issue when it comes to men who have sex with men in Jamaica and look at the terrible culture of homophobia that is pervasive throughout the country. So there is a sodomy law — gay men’s lives are criminalized. So, in one of the segments thatWorldfocus aired earlier this week, in fact, there was a gay man who said, “AIDS is not killing us, people are killing us” referring to the very high murder rates of gay men in Jamaica.

Daljit Dhaliwal: Do you think it would make a difference if these laws around sodomy were decriminalized in Jamaica?

Julia Greenberg: I think it would be part of making a difference. I think we have to attack it several different ways. One is definitely getting rid of this sodomy law, which criminalizes sex between men. So if you’re going to do effective prevention for the population most affected by AIDS in Jamaica you would have to actually talk about the kind of sex that they engage in, and you can’t do that because that kind of sex is against the law.

Daljit Dhaliwal: And in terms of the big picture in Jamaica and in other parts of the Caribbean, do you think in the discussion of HIV and AIDS that we are moving away from treatment to prevention, or not?

Julia Greenberg: Well, I think the Caribbean is a perfect example of why we have to do both. So let’s look at treatment for a second. Jamaica has 43 percent coverage rates. So, 43 percent of the people who need AIDS treatment to extend their lives right now are getting it. Then, if you look at the prevention picture overall in the Caribbean, for every five (5) people put on treatment, 10 are newly infected. So we’re swimming against the tide. And it’s my opinion and I think the growing understanding in the AIDS movement that if you want to effectively deal with prevention, you have to deal with the concentrated epidemics among men who have sex with men, sex workers and in some regions drug users.

Daljit Dhaliwal: Right, and these trends that you’re talking about in Jamaica, do they also reflect a pattern in other parts of the Caribbean or is it too much to generalize? As far as you can generalize, what would you say is going on?

Julia Greenberg: They absolutely reflect a trend. If you look at Trinidad and Tobago, the prevalence rate is 1.5 in the general population and it’s 20 percent among men who have sex with men. In the Dominican Republic, for instance, where there isn’t a sodomy law, I believe the general prevalence rate is 1.1, and it is 11 percent in the gay population. So, it’s less than of a divide and maybe that speaks about the criminalization of gay men’s lives. But the trends are absolutely across the board similar.

Daljit Dhaliwal: In terms of Jamaica’s anti-sodomy laws, they would say, “Why is Jamaica always having the finger pointed as us? There are other countries around the world that also have anti-sodomy laws?” What would you say to them?

Julia Greenberg: I would say that’s true. I think there are about 80 countries around the world with sodomy laws or some kind of laws that criminalize relationships between men or relationships between women and women. And I think that’s really important. Look at the United States — it was only in 2003 that our Supreme Court ruling essentially nullified all state sodomy laws. So, that’s true. I would point to the recent Human Rights Watch report on the militia-sponsored attacks against gay men in Iraq. It would make your blood turn cold to read these reports. So, it’s a problem all over the world, absolutely. But the quality of the violence in Jamaica is quite stark. In fact, there are immigration lawyers here in the U.S. working with asylum seekers from Jamaica and they say that across the board, the quality of attacks is extreme, and, in fact, it makes it easier for them to win cases because of the nature of the violence perpetrated against the gay community there.

Daljit Dhaliwal: Is there some insight you can give us as to why this culture of homophobia is so pervasive in Jamaica, say, compared to other parts of the world? Are there cultural factors that make it that way?

Julia Greenberg: The story that is important to understand and tell, but is really difficult to face in Jamaica is that the prevalence is so high in the gay community and stigma is so strong, that gay men are getting married or having female partners and they’re acting as a bridging population to the heterosexual community, and specifically women. And that’s not something that’s discussed. It’s a very difficult issue to discuss again because of the culture of homophobia, but also because it feeds into homophobia. So then, the homophobic elements in the culture can say, “See these gay men are infecting our innocent women.” And, obviously, that’s not the picture.

Daljit Dhaliwal: And what role is Jamaica’s government playing? Could it be doing more? Is it doing what it can do with the money and resources it has available within its widerhealth care budget?

Julia Greenberg: Well I’ll break it down again between the government and the Ministry of Health. So the government has said some terrible things about how they’ll never repeal the sodomy law, the prime minister has said he’ll never have a gay man in his cabinet. So there is a lot being done at the highest levels of government to fuel homophobia. And when homophobia is fueled, you’re not going to, again, contain the AIDS crisis. The Ministry of Health is another story. They’ve recognized that they’re not going to get their job done unless they deal with the epidemic among men who have sex with men.

Again, if I might refer again to one of the Worldfocus segments, the former head of the national AIDS control program said, “It would be good if we could repeal the sodomy, and that the entire government and Ministry of Health needs to understand that they’ve failed when it comes to prevention.”

Daljit Dhaliwal: Is it a political issue for the Jamaican government that they don’t want to decriminalize or repeal the sodomy law, or is it more to do with this culture of homophobia, which you’ve been describing?

Julia Greenberg: I think it’s really integrated and complex. I think it’s a political issue because it really is ingrained in the culture and the society and there would not be popular support for such a move.

Daljit Dhaliwal: Give us a sense of what Jamaica has done — the kind of progress that it has made. And give us some context about the antiretroviral drugs, which have been provided by Jamaica, which are free, whether they are accessed or not accessed by individuals.

Julia Greenberg: There’s been an increase in the uptake of antriretroviral drugs in Jamaica. And it’s fantastic that they’re given for free. They are now achieving 43 percent coverage of people who need the treatment. But it’s important to state that the global community — the heads of state, the U.N. — have all said that universal access must be achieved by 2010. We’re about a third of the way there, and Jamaica is only a little ahead of the curve.

Daljit Dhaliwal: Is Jamaica unique in using community liaison groups and individuals like Ida, the woman that we saw in our film, in terms of educating communities and trying to reduce the stigma around HIV and AIDS?

Julia Greenberg: I wouldn’t say they’re unique. I think it’s been generally understood because of activism in the global AIDS advocacy community, that communities have to be involved in every aspect of AIDS prevention and support. So, governments are actually required to have communities involved in all of their programs. It seems to me that the Jamaica program is quite strong. The parish AIDS communities seem to be doing really great work. And you see communities adhering to their drug regimens and really absorbing prevention messages when they’re working with community leaders such as Ida.

Daljit Dhaliwal: Give us some examples of the kind of grassroots campaigns that these activists are involved in. And can you share some of the strategies that they are using, which perhaps have or haven’t worked, or you feel you can make better?

Julia Greenberg: To say grassroots campaigns is to overstate it because the lesbian, gay, transgender community in Jamaica has to basically exist underground. Again, as one of the excellent segments you aired shows, if you so much as embrace in public you’re at risk of being attacked by a mob. So, the kind of work the gay community is doing is underground, it involves speaking out when the government or the church says something egregious about the lives of homosexuals and how they should be criminalized, how they’re an abomination in the eyes of the lord.

Daljit Dhaliwal: So what is the best way of tackling that?

Julia Greenberg: Tackling that? I think one of the most important ways is finding leaders within the culture, in the church, in the communities — where you can find an opening. Where they’re willing at least to say that it is not OK to beat or kill gay people. And start working with them to see if they can begin to take a leadership role in making changes.

Daljit Dhaliwal: Let’s talk a little bit about how women are being infected by these “bridging” populations and the way in which they access treatment. Does it happen along gender lines that they have difficulty accessing treatment? Or, are they more stigmatized as a group if they become infected? What is the role of women in HIV and AIDS in Jamaica?

Julia Greenberg: Again, it’s another complex picture. When I was there last February I had the opportunity to meet with a group of HIV positive women at the office of an excellent organization called Jamaica AIDS Support. And these women, I have to say, after spending 10 years working in sub-Saharan Africa in some of the poorest communities in the world, there was no difference between the lives of these women and lives of the women that I met in my work and my travels in Africa. The stigma is intense. The poverty is intense. They’re not able to stay on their drugs for lack of food. They’re not able to get to the clinics for lack of transportation.

Daljit Dhaliwal: Right, and what kind of role can these women play in helping to lessen the epidemic?

Julia Greenberg: I’ve talked to a lot of activists about this — how can we get the gay community and the women’s rights community together talking about this issue. And it’s not happening yet. It really needs to happen. There needs to be an understanding that both communities are affected and they’re in it together.

Daljit Dhaliwal: There is also a culture of blame, as well.

Julia Greenberg: There is a culture of blame.

Daljit Dhaliwal: How do you get beyond those very, very emotional issues when a women becomes infected by a man she thought was straight, and it turns out he’s bisexual or he’s gay? How do you have those conversations?

Julia Greenberg: I don’t think those conversations as far as I understand — they may very well be happening at a personal level, but they’re not happening at a national level or even an organizational level, among the organizations that are working on this issue. It’s really, really tough.

Daljit Dhaliwal: Alright, Julia Greenberg, thank you for talking to us and giving your insights.

Julia Greenberg: A pleasure to be here, thank you.

Lisa Biagiotti produced this interview.

The results were described as a major step forward in the development of a vaccine against AIDS, a disease that kills an estimated 2 million people worldwide each year and infects 7,500 people each day.

Jessica Justman, the senior technical director and assistant professor of clinical medicine in epidemiology at the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University’s Mailman School of Public Health, joins Daljit Dhaliwal to discuss the significance of the study and prospects for the future.

If an AIDS vaccine were available, would you take it?

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Micah Fink of the Pulitzer Center on Crisis Reporting produced the Worldfocus signature story “Jamaica’s battle against AIDS fought in the shadows.” He breaks down the statistics that have been used to characterize Jamaica’s HIV/AIDS epidemic and its impact on the gay community.

Numbers, statistics and dates are notoriously difficult elements in any television script.

Most people find it hard to catch numbers on the fly. And when it comes to complex statistics, well, let’s just say that hearing them as a spoken word makes them even harder to grasp than usual.

So what does it mean when we report that a recent Jamaican government study found that nearly one-third of gay men in Jamaica is HIV positive? Is this a high number or a low one? Is just one isolated study really significant? And how does Jamaica’s infection rate in the gay community compare with levels of infection in other countries?

While these questions are too complicated for a six-minute television broadcast, they are more easily addressed in print. So here are seven facts and one extrapolation to help place these figures into context.

Fact # 1: When we say that nearly 32 percent of Jamaica’s gay community is infected with HIV, we are referring to a study conducted in 2007-2008 by the Jamaican National HIV Control Program. This study was the very first controlled study of HIV rates in Jamaica’s gay community and found a 31.8 percent infection rate among the 201 gay men tested. More than half of the gay men tested were between 20 and 29, and nearly 30 percent of the group reported not using a condom when they had sex during the past month. Eighty percent of the men studied reported having two or more male sexual partners during the past year. And interestingly, 33.8 percent of the total group also reported having sex with at least two female partners in the previous year.

Fact #2: “Controlled study,” by the way, means that the researchers linked the anecdotal reports of each individual person studied with their actual blood test. This technique is generally considered a very reliable way to conduct HIV research.

Fact #3: HIV has been infecting people in Jamaica for more than 25 years. The first case of AIDS was identified on the island in 1982, but for several reasons the folks in charge of the national response didn’t decide to study how deeply the virus had penetrated the gay community until 2007-2008.

Fact #4: Only one other study of HIV infection rates in Jamaica’s gay community has ever been conducted. It was done more than 10 years ago, in 1996, by Rossi Hassad, a graduate of the University of the West Indies and public health researcher. Hassad reported that 31 percent of the gay men he tested were infected with HIV. This study was never officially confirmed or accepted by the Jamaican Ministry of Health.

Fact #5: Based on the results of these two studies –- Hassad’s in 1996 and the National Program’s in 2008 - – it seems apparent that HIV infection rates have likely been hovering between 31 percent and 32 percent for more than a decade.

A fly-by-night extrapolation: I had to “run the numbers” for myself to begin to understand the implications of these studies for Jamaican society. A conservative estimate used around the world suggests that about 10 percent of the total number of men in Jamaica may engage in homosexual activities. Given a total population of 2.7 million, and a fairly equitable breakdown of the sexes -– let’s say 49 percent of the total population — we come up with a total male population of roughly 1.3 million individuals. Dividing by ten percent gives us an estimate of 130,000 gay men in Jamaica. Extrapolating from the Ministry of Health recent study means that 30 percent of this number are infected with HIV, and we arrive at the conclusion that some 39,000 gay Jamaican men may now be infected with HIV. Curiously, this number exceeds the Ministry of Health’s current estimate for the total number of HIV cases in all of Jamaica, which is about 36,000 cases. This inconsistency is worth pondering.

Fact #6: The Ministry of Health’s finding that 31.8 percent of the gay Jamaican men are infected with the virus that causes AIDS is alarming. However, when it is discussed in reports to international agencies like UNAIDS, the numbers are played down as a “concentrated” epidemic. But what is a “concentrated” epidemic? This term is how public health official now refer to infections within a specific sector of society, as opposed to infection rates in all of society, which is known as a “generalized” epidemic. Concentrated epidemics are now found in gay men, sex workers, handicapped communities, intravenous drug users and prisoners in Jamaica. However, calling these epidemics “concentrated” seems a bit misleading, since members of these “communities” are seldom, if ever, really isolated from rest of the general population. For example, as we saw above, more than one-third of the gay men studied reported having two or more female partners in the previous year. Clearly, the gay men in Jamaica, not to mention sex workers and prisoners, have strong sexual links to the “general population.”

Fact #7: Jamaica is not the only country in the world now reporting high HIV infection rates in local gay communities. Recent research on HIV rates in gay communities around the world –- particularly in developing countries –- has found similarly high “concentrated” infection rates. Recent testing in gay populations in Mumbai, India, found a 17 percent infection rate; in Bogotá, Columbia, 20 percent of the gay men tested were infected. Two years ago, Mexico reported a 15 percent infection rate and an older study in Trinidad topped the list by reporting a 40 percent infection rate in the local gay community.

- Micah Fink

• Watch all the Worldfocus In the Shadows video signature series
• Listen to Worldfocus Radio on LGBT politics and gay asylum
• For more information on homophobia and HIV in Jamaica, visit The Glass Closet, a multimedia project produced in partnership with the Pulitzer Center on Crisis Reporting

Correspondent Lisa Biagiotti, producer Micah Fink and director of photography Gabrielle Weiss report from the front lines of Jamaica’s battle against HIV and AIDS, a war waged in the shadows.

• Watch all the Worldfocus In the Shadows video signature series
• Listen to Worldfocus Radio on LGBT politics and gay asylum
• Read Lisa Biagiotti’s blogs: There are no gay pride parades in Jamaica and Gay men in Jamaica must lead two separate lives
• For more information on homophobia and HIV in Jamaica, visit The Glass Closet, a multimedia project produced in partnership with the Pulitzer Center on Crisis Reporting

However, WHO officials are warning that the pandemic will hit poor countries especially hard. At the United Nations meeting in New York later this week, those officials plan to ask wealthy countries to contribute to a special fund for the developing world.

Michael Novacek, the provost of science at the American Museum of Natural History, joins Daljit Dhaliwal to discuss the dangers and the production and distribution of vaccines.

In China, a massive campaign to vaccinate people against swine flu began in Beijing on Monday. It is thought to be the first nation to begin inoculating its population against the H1N1 virus.

China has been among the world’s leaders in developing a swine flu vaccine, with no fewer than five Chinese drug makers involved in the effort. Chinese officials hope to vaccine 65 million people by the end of the year — about five percent of that country’s population.

In Mexico, officials are predicting as many as five million cases of swine flu this winter, with some 2,000 deaths. Earlier this year, Mexico was ground zero for the pandemic, but was able to bring it under control by shutting schools and businesses for several weeks.

This time, Mexican officials are promising such closures will be more focused; just recently, some 1,400 schools in one northern city in Mexico were closed after a reported outbreak.

Swine flu has hit South America hard. Brazil is now reporting some 900 deaths due to the pandemic, more than any other country in the world. According to the World Health organization, there are now nearly 300,000 case of swine flu worldwide, with nearly 3,500 deaths.

View our Health of Nations series for videos and blogs exploring different health care systems in countries like the United Kingdom, Singapore, Canada, China and beyond.

Are you convinced that health care in the United States is as good as that in other developed nations?

Tell us what you think in the comments section below.

Victor Rodwin, a professor of health policy and management at New York University’s Wagner School of Public
Service, joins Daljit Dhaliwal to discuss global health care systems and how the U.S. health care debate is being perceived overseas.

Al Jazeera English’s Teresa Bo reports on the anger surrounding the deteriorating conditions in many of the Argentina’s hospitals.