Martin Savidge hosts David Rayside and Rachel Tiven on LGBT politics and gay asylum. We begin the conversation with Jamaica, which makes up 17 of the 55 U.S. asylum cases won by Immigration Equality last year alone. We examine the metastasizing colonial and slave culture, entrenched poverty and rampant violence in Jamaica.

In 1994, former U.S. Attorney General Janet Reno expanded asylum law to include persecution based on sexual orientation. Sexual orientation has been increasingly used as grounds for asylum. We also discuss how to begin the process of applying for gay asylum in the U.S.

From human rights abuses to political progress, the gay rights movement is at different stages throughout the world. We take a comparative look at the progress of LGBT politics and the gay rights movement in different countries, including the best and worst places to be gay.

A Greek gay rights parade. Photo: Megan Thompson

• Read about one gay Jamaican’s story of asylum: Gay men in Jamaica must lead two separate lives
• Watch signature videos from Jamaica: Violence and venom force gay Jamaicans to hide and Gays in Jamaica worship in underground church
• Watch our signature video from Greece: Ancient Greek values clash with modern treatment of gays

GUESTS:

David Rayside is a political science professor at the University of Toronto. His latest book “Queer Inclusions, Continental Divisions” is a comparative analysis of Canadian and  American political recognition of same-sex relationships, the extension of parenting rights to same-sex couples and the response to sexual diversity in public schooling. For over thirty years, he has also been an activist on issues related to sexual diversity and gender within academic institutions and beyond.

Rachel B. Tiven is the executive director of Immigration Equality, a national organization fighting for equal immigration rights for the lesbian, gay, bisexual, transgender and HIV-positive community. Under her leadership, Immigration Equality has doubled in size, quadrupled client services and opened a policy office in Washington, D.C.

Credits:
Host: Martin Savidge
Producers: Lisa Biagiotti and Ben Piven
Researcher: Geneva Sands-Sadowitz

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 on the secret underground church that is welcoming gay men and women to practice their faith. Reverend Robert Griffin, an American priest, leads the secret church.  He believes religion is at the heart of Jamaica culture of homophobia, and the time has come to reinterpret the Bible for modern times.

• 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 on the dark side of Jamaica’s anti-gay violence and attitudes and explore the ideological beliefs that perpetuate a culture of homophobia.

• Read Protecting our gay Jamaican sources and their confessions
• 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

The signature story Violence and venom force gay Jamaicans to hide reports on the dark side of Jamaica’s anti-gay violence and attitudes and explores the ideological beliefs that perpetuate a culture of homophobia.

Producer Micah Fink of the Pulitzer Center on Crisis Reporting produced the Worldfocus signature story “Violence and venom force gay Jamaicans to hide.” He explains why we had to protect peoples’ identities.

For more information on HIV and homophobia in Jamaica, visit The Glass Closet, a multimedia project produced in partnership with the Pulitzer Center on Crisis Reporting.

Reporting for television on anti-gay violence in Jamaica is tricky.

It is widely believed that being openly gay in Jamaica is essentially a death sentence. That eventually, if you put your face on camera and admit you are gay, someone, sooner or later, will come along and kill you. Or attack your family. Or kill you and your family.

So we had to accept that anyone gay would not be willing to appear on television talking openly about their life experiences. We also agreed before we began filming that if we did find people willing to tell their stories, we would conceal their identities.

And we met many people, more than we could film, who were willing to be interviewed – and who trusted us to protect them from retribution.

There were only two exceptions.

One was a young gay woman who had been brutally attacked by anti-gay thugs and who was planning to flee Jamaica forever and apply for asylum in the United States. She agreed to openly tell her story as long as she was safely off the island when the film was broadcast. Unfortunately, her request for an American visa was denied, and she remains trapped in Jamaica, fearing for her life. And the footage we shot with her will likely never see the light of day.

The other exception was Reverend Robert Griffin, a gay American minister with the Metropolitan Community Churches, who agreed to appear on camera to tell the story of his efforts to build an underground church for Jamaica’s gay community. He is aware that he is risking his life by showing his face to the camera – since he often travels back and forth between Jamaica and the US – but he believes this is a risk worth taking. He sees himself as part of a long tradition of fighting for civil rights that passes through Martin Luther King and connects back to the anti-slavery movement and the underground railroad. And he believes that fighting for tolerance and human dignity for Jamaica’s gay community is a cause for which he is willing to risk everything.

Everyone else wanted to appear in silhouette.

I wasn’t sure at first if these darkened features, shot against a bright window frame, would convey the emotional intensity that is so essential for effective television story-telling. But after we filmed several young gay men speaking about their lives, it was clear this was material we simply had find a way to use.

I now think that the absence of specific visual details makes you listen more closely to the humanity of these voices, and that their remarks may even be more chilling and more universal than if you were able to see a particular, individual face.

“If you are gay in Jamaica, people want to kill you,” one young man told us, explaining how he has to change how he walks and talks so that he doesn’t draw attention to himself when he walks outside. “So I try to walk thuggish,” he explains.

Another young man tells us that he is now living in hiding. “Where I live it is very dangerous,” he says. “Most of the time I can’t come out during the day because people want to kill me.” Why do they want to kill him? “Because I’m gay,” he says.

He also tells how his best friend was murdered and chopped into tiny pieces – and how another friend was locked into his parent’s home and then burned alive.

“People who live here, once they find out that you’re gay, Battyman, let me use the word Battyman, they want to kill you,” says another young man. He goes on to explain that the police are also a serious threat. Just last week, he says, he was searched by several police officers who “razzle dazzled” him up, and then told him: “Bataman fi dead around here,” which means, translated from Jamaican, “We kill gay people around here.”

How do I know they were speaking the truth?

Partly from my 15 years of experience as a journalist—my inner sense told me while we were filming that these men were speaking openly about their lives. Most were poor and had nothing to gain from making up stories. And then there were the common themes that run through their accounts—that make their stories similar, while still being unique. Most of these men said they were afraid to disclose their sexual identity to their parents, or families, or girl friends, for fear of being rejected or expelled from their homes.

And then there are the odd, but very human inconsistencies.

Listen closely to the young gay man who goes by the pseudonym Damion and who says he believes that homosexuality runs counter to God’s will. “I read the Bible for myself and see in the Bible where it says Sodom and Gomorrah is wrong and God destroyed them, so I believe the practice is wrong,” he explained. “So what we need to do is try and put that in a restraining order and stop doing it.” he says. “It is a big challenge for your lifestyle to be changed from homosexual, to be free from it. I believe you need to go through a lot of prayer and fasting, dedication, commitment, and counseling that would help to bring you through that process. It is very hard to do, but I believe it can be done. I’m trying to climb that ladder but I keep falling back because it’s very hard to do. It’s very difficult to change your lifestyle.”

This is the confession of a man struggling with himself—his conscience battling both his sense of morality and his innate sexuality. Given the social context in which he lives, this seems to me to be a battle that he can never really win. Which I find as profoundly tragic as it is profoundly true.

- 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.

Producer Gary Strieker reports from Ethiopia’s Amhara region where 60 percent of children suffer from trachoma.

For more on Worldfocus’ coverage on Ethiopia, click here.

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.

Violence and hatred lurk close to the social surface in Jamaica.

Producer Micah Fink of the Pulitzer Center on Crisis Reporting produced the Worldfocus signature story “Jamaica’s battle against AIDS fought in the shadows.” He reflects on Jamaican culture and the homophobia that has contributed to the country’s HIV/AIDS crisis.

Jamaica, to me, is a land of deep contradictions.

On one hand, it’s a lovely, lush tropical country, blessed with sandy beaches, fantastic flowering shrubs, ripe mango and coconut trees, and inhabited by a strong, proud people who clearly share a basic sense of personal dignity and a deep-seated hospitality towards strangers. I found this to be true regardless of whom I was speaking with, be they rich or poor, educated or illiterate, straight or gay.

At the same time, I also encountered an intensity of violence and hatred lurking close to the social surface that shocked me. I was amazed at how easily people expressed their disregard for the human rights of gay people. Or how the same individual could argue that most violence against gays is carried out by other homosexuals while also acknowledging how “understandable” it is that gay people would be beaten by a mob, perhaps even killed, if they “flaunt” their sexual identity in a public space.

I was also surprised by the homophobic venom expressed, openly and on-camera, by the political leaders we met. Perhaps it was to be expected from Representative Ernest Smith, an outspoken opponent of gay rights, but I felt side-swiped to hear similar views expressed by the Reverend Bishop Herro Blair, who is Jamaica’s Political Ombudsman and widely credited with reducing political violence in Jamaica’s inner cities. And I was stunned when their most inflammatory remarks were repeated by leading public health officials, teen-aged school children, and, sometimes, even by members of Jamaica’s gay community.

The ideology of homophobia is as deep as it is pernicious in Jamaica.

It is widely held that homosexuality is a mortal sin, which the Bible (and by extension God) has ruled should be punished by death. And if that wasn’t inflammatory enough, there is a wide-spread perception that gayness is transmitted by homosexual contact (gays are made, not born) and that gay men and women are out actively raping young Jamaican children to “recruit” them into a new generation of homosexuals. Many people also seem to believe in the existence of an “international gay lobby” that is conspiring to undermine and destroy the nation’s moral values and political sovereignty.

In the context of HIV and AIDS, of course, these attitudes are deadly. So it wasn’t surprising for me to meet a young gay man who rejected every safe sex message ever created. “It’s not AIDS that is killing us,” he told me. “If it were, I would use a condom. But it’s people, not AIDS, that is killing us. AIDS has nothing to do with it.”

Jamaica, it seems, needs to be reminded of another old biblical adage, expressed succinctly in Galatians: “You shall reap what you sow.”

- 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

Now, Worldfocus partner The Media Line reports that salt therapy is catching on in Jerusalem.

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.

Melissa Chan of Worldfocus partner Al Jazeera English explores the state of health care in China and challenges faced by the government.

Comments about Britain’s National Health Service (NHS) — some calling the system “evil” or “Orwellian” –  have drawn the attention of many U.K. residents, including Prime Minister Gordon Brown, who this week joined a Twitter campaign to defend health care in his country.

Andrew Clark, the New York correspondent for The Guardian, joins Martin Savidge to discuss how Britons view the U.S. health care debate.

Below, read comments from British bloggers who defend their health care system.

For more on alternative health care systems around the world, see the Worldfocus signature series “Health of Nations.”

British Twitter users have launched a campaign to defend the NHS, using the hashtag #welovethenhs.

Gordon Brown was among the many who participated in the campaign, tweeting:

PM:NHS often makes the difference between pain and comfort, despair and hope, life and death. Thanks for always being there

Another Twitter user, Andrew Learmouth in Aberdeen, writes:

I’d be dead, my mum’d be dead and my dad wouldn’t be getting a new knee if it wasn’t for the NHS. Worth every penny

Geraldine in the U.K. chimes in:

went private when I was rich, used NHS when I’ve been poor. No diff in level of care whatever. Happy to pay taxes for it.

Steve Ince in East Yorkshire adds:

Many of my family would have no quality of life without the wonderful work of the NHS and the hardworking staff. Thanks!!!

Bloggers, too, shared their experiences with Britain’s health care. Gareth Wyn in Stockwell, London, explains his own reasons for supporting the NHS:

The American Right seem to be getting their knickers in a twist, all over the fact that the Obama Administration wants to provide them with a basic level of health care and that the NHS is so bad that people are being left to die in hospitals. [...]

I suspect that no one would claim that the NHS is perfect but it saved my life and that of my mother when I was born, it was fabulous when my grandparent were alive and even when they were near death. My mother, father, uncles have all had fabulous treatment for cancer related illness, I’ve had wisdom teeth extracted, a number of surgical procedures, all for free. I am able to call the doctor at 8.30 to make an appointment, and will have seen him and be in work by 10.30. Cost nothing except my tax payments. In fact I would be happy to pay a bit more tax if it meant an even better service.

Blogger Sarah in Cambridge shares her own experience:

Word of this is getting around - apparently in order to discredit the, as I understand it, somewhat limited reforms that President Obama is proposing for the US’s very expensive, and not all that effective health care system, right wing pundits in the US have been using the NHS as a scare story about all the bad things that can happen under “socialised medicine”.

I want to make a personal point. When I was eight years old I was walking home from school one day. An illegally parked truck was blocking my view along the road. I edged out to look round, and at that moment I’m told someone stepped out from one of the garden gates on the opposite side. A car which was travelling along the road swerved to avoid them, and narrowly missed the truck I was peering out from round.

I experienced this as a screeching of brakes, at which point I guess I must have had a ton of adrenaline dumped into my system. I came to rest on my back [...] I felt a pain more intense than anything I’ve ever experienced in my stomach - far more pain than an eight year old should have to deal with. I looked up to see a circle of faces looking down at me.

In due course an ambulance arrived. It took my to the Chesterfield Royal Hospital where I spent a week on the Nightingale Children’s ward in a lot of pain, being fed through an IV line in my arm, feeling deeply sorry for myself.

Through all of this there were no insurance companies involved, nobody ever asked how the x-rays, the doctors, the medicine, the bed, etc. were to be paid for, no questions were ever asked about whether we had “coverage”, they just sent an ambulance, took me into hospital, looked after me for a week, and got me back in a fit state to be sent home. When I was eight years old the system the US right wing wants to portray as some kind of socialist dystopian disaster simply did its job and saved my life.

So yeah, thanks for that NHS, and don’t believe everything you see on the television, especially if there are political lobbyists involved.

An American blogger living in London compares the U.S. and U.K. health care systems:

I figured I could add some of my own experience with NHS since I moved to London.  Like most Americans exposed to anti-socialist rants on the poor quality of socialized healthcare, I was a bit wary and skeptical.   Would I be waiting in line for hours?  Could I trust the quality of care? Would the system be unnavigable and complicated?  Fortunately, my experience was quite the contrary.

I felt it was important to share this after reading and watching some of the anti-healthcare reform initiatives spreading back home.  The system is efficient, provides satisfactory care and it’s FREE.  Totaling up everything I’ve had done since my arrival here, I probably would have had to pay around $2,000 back home

Teresa Bo of Worldfocus partner Al Jazeera English travelled to Port-au-Prince to see how expecting mothers are coping.

For more on humanitarian conditions in Haiti, see our extended coverage page on Haiti’s Poor.

Health care in China comes at a fraction of the cost compared to the U.S., writes Peter Eisner.

Here’s an antidote to the delirium pills that some in the U.S. health care industry want us to swallow during the universal health care debate. The fact is that many countries think that good health care is a right, not a privilege; as a result people don’t have to mortgage their lives when they get sick.

The latest case I’ve come across is a report from a close friend who just back from the central Chinese city of Wuhan — population at least 6 million, 650 miles west of Beijing.

She woke up one day with a painful case of shingles, a nerve disease produced by the chicken pox virus that can lie dormant in the body for years. By the second day, it was clear that she needed to see a doctor. But she had no idea of how the Chinese medical system works, and doesn’t speak Mandarin.

First, she telephoned a doctor in the United States, who confirmed that she did in fact require treatment right away.

Then, with the help of a translator, she went to an outpatient clinic at Wuhan University Hospital. She was examined, diagnosed and treated in less than one hour. She had feared primitive conditions and scant supplies, but encountered an efficient, patient-friendly system. She saw both a dermatologist and an ophthalmologist who worked in a well-organized setting, including computer tracking of each patient. The doctors confirmed the diagnosis of shingles, and they set out a regimen of treatment.

After that, she was straight off to the billing window — the visit with the two doctors totaled 8 Yuan, little more than $1. And then another quick stop at the pharmacy, where she filled four prescriptions. The bill: 136 Yuan, about $17.

She called home to tell a doctor about her treatment; the physician was impressed, and said the medicines prescribed were well chosen, including the latest anti-viral product.

Two weeks later, the medicine was doing the job and she improved every day, still on the road. For those who complain about discussing medical care in a Communist country, the next stop was Japan, where my friend also had quick, efficient and reasonably-priced checkups.

Her husband concludes, “We can learn from our less-developed Asian counterpart and the more modern Japanese system. The care we experienced randomly was quite professional, effective, expedient, endorsed by the U.S. medical personnel we consulted, and inexplicably inexpensive.”

Case closed.

- Peter Eisner

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

In Cambodia, health officials are seeing new evidence of resistance as they try to treat the most deadly kind of malaria.

The concern is that this deadly strain will spread to Africa with devastating results, as Gary Strieker reports, in association with the Global Health Frontline News Project.

For more, watch the Signature Story “Cambodia fears growing resistance to malaria drugs.”

Michael Novacek, the provost of science at the American Museum of Natural History, joins Martin Savidge to discuss fears that deforestation and global warming are contributing to the spread of malaria, as well as what scientists are doing to fight the disease.

The Naxalites are an assortment of violent Maoist rebel groups who stage internecine attacks on Indian government targets to bring attention to region’s blight. With about 20,000 fighters, the Naxal-Maoist Insurgency rages in 40 percent of India’s territory. Prime Minister Manmohan Singh called the Naxalites India’s biggest threat to national security, and they continue to attract support from a wide array of castes and tribal groups.

India’s Naxal-affected districts (red signifies most influence) Map: Wikipedia user Planemad

While conducting malnutrition research in the heavily tribal state of Jharkhand — one of India’s most impoverished states — one woman told me this story:

My one-year-old son fell sick one day. The nearest health center is 20 miles away. Going there would mean losing a day’s wage. The whole family would have to go without food that day. I had other children to feed, it was not possible. My son slowly got too weak to play, to stand up and one day he died.

Villagers with stories like this strengthen the Naxal insurgency in the region. Data shows that India’s child malnutrition rate is 47 percent (as compared to 30 percent in sub-Saharan Africa). India also ranks 66th among the 88 countries in the 2008 Global Hunger Index.

Schoolchildren in heavily tribal Jharkhand on Republic Day. Photo: Flickr user premasagar

In 1967, the Naxalites started their revolutionary movement in a small West Bengal village called Naxalbari. With huge support from highly-marginalized tribal communities, the Naxalite-controlled “Red Corridor” starts in Andhra Pradesh and runs through eastern Maharashtra, Madhya Pradesh, eastern Uttar Pradesh, Chhattisgarh, Jharkhand, West Bengal and Bihar.

Labeling this highly complex issue a matter of law and order, the West Bengal state government sent in police and paramilitary forces and recently banned the Maoist party after recent violence in Lalgarh, West Bengal. And by pigeonholing the Naxalites as “terrorists,” the government has further isolated Naxalite supporters.

But government forces have been accused of gross human rights violations. For each alleged government abuse, the Naxalites have responded with double the level of violence. Large-scale killings increase during elections when Naxalites take passenger trains hostage and launch attacks on police. The Naxalite ideology has led both sides onto a path of increasing bloodshed in a “brutal low-level war.”

Naxalism is a complex social issue with roots in the tremendous deprivation of millions of rural Indians. Negating the politics of development could help turn Naxalism into a true mass movement. Time will tell whether this will create a much larger civil war or be crushed by the state.

More likely than not, Bastar in Chattisgarh, Palamau in Jharkhand and the thousands of other forgotten Indian hinterlands will continue to bleed.

In the Naxal belt and beyond, millions of Indians — just like the woman who lost her son — will continue to starve.

- Anasuya Ray

Environmentalists and others may balk at the world’s rapid population growth, as the global population is expected to surpass 9 billion by 2050 — but in Russia, the opposite is true.

Facing dual threats of low birth rates and soaring mortality rates, the Russian population is aging and dying, according to a recent report from the United Nations Development Programme.

Life expectancy in Russia is some 12 years less than life expectancy in the U.S. Russia lost more than 12 million people over the last 16 years, and may lose another 11 million by 2025.

In an effort to combat the trend, the Kremlin has launched a pro-natalist campaign, expanding maternity leave benefits and offering financial incentives to mothers with more than one child.

The population decline has also impacted Russia’s national discussions on reproduction and abortion.

Worldfocus.org’s weekly radio show explored the factors driving Russia’s population decline and its implications for Russian society and public policy.

Worldfocus anchor Martin Savidge hosted a panel of guests:

Paul Goble is a longtime specialist on ethnic and religious questions in Eurasia and blogs at “Window on Eurasia.” Most recently, he was director of research and publications at the Azerbaijan Diplomatic Academy. Previously, he worked in various capacities at the U.S. State Department, the Central Intelligence Agency and the International Broadcasting Bureau, as well as at the Voice of America, Radio Free Europe/Radio Liberty and the Carnegie Endowment for International Peace. He has been decorated by the governments of Estonia, Latvia and Lithuania for his work in promoting Baltic independence.

Vladimir Lenskiy is the New York bureau chief and correspondent for Russia’s Channel One television, the country’s oldest and largest television network with an audience of 100 million viewers throughout Russia and Eastern Europe. He has over a decade of experience as a reporter for Russia’s independent national television networks, including NTV (Nezavisimoye Televideniye), TVS and TV-6, a Moscow-based independent channel.

Louisa Vinton is a senior program manager at the United Nations Development Program’s Regional Bureau for Europe and the Commonwealth of Independent States, where she is responsible for UNDP activities in seven countries: Armenia, Azerbaijan, Belarus, Georgia, Moldova, the Russian Federation and Ukraine. Previously, Louisa worked for the Economist Intelligence Unit and as a senior research analyst for Radio Free Europe/Radio Liberty in Munich.

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

Credits:
Host: Martin Savidge
Producers: Nicole E. Foster, Katie Combs and Bijan Rezvani

Stephen Morse, a professor of clinical epidemiology at Columbia University’s Mailman School of Public Health, discusses how he sees the H1N1 flu epidemic playing out over the next few months in Mexico, the U.S. and the world. 

Below, Professor Morse answers viewer questions. Thank you for your submissions.  

Q&A:

William in New York asks: How do people become infected with the swine flu? Is it airborne, is it
contact with a person or an object an infected person has touched, or both?

Professor Morse: Probably mostly airborne. The swine flu is exactly like the regular flu we’re all familiar with in its physical properties and transmission.

It’s hard to believe, but after all these years of studying –- and experiencing — the flu, we still aren’t absolutely sure about all the mechanisms of transmission. But we can make some good estimates. I suspect that most infections are probably airborne, especially when people cough or sneeze nearby. Contact or inanimate objects are probably much less important as ways to become infected, although it’s still an open question and may account for some cases.

Because of the airborne spread, cover your coughs and sneezes (and if you can, throw away the tissue and wash your hands afterwards), and if possible stay at least several feet away from people who are coughing or sneezing. Because of the possibility of contact transmission, we also recommend good “hand hygiene” –- washing your hands (or using a hand sanitizer) regularly. We’re not sure whether or not handwashing makes a big difference with flu transmission, but it has clearly been shown to prevent many other infections and is a good simple precaution.

James in Michigan asks: The virus has three different strains of D.N.A — human, avian and pig. Can it jump from species to species, if the virus is compatible with the species? If so, shouldn’t we be concerned about that?

Professor Morse: Influenza viruses are exchanging genes all the time, often without our noticing until disease occurs. Influenza Type A — the one we usually are referring to — has its genome divided into eight segments of RNA (you can think of them as “mini-chromosomes”). The segments make it easier for the influenza viruses to exchange genes, a process we call reassortment. This is the process that usually gives us new pandemic strains. The widest variety of influenza viruses live in waterfowl, such as wild ducks or geese, and the novel gene in a pandemic usually ultimately comes from this source. However, humans are generally very resistant to infection by these avian (bird) influenza viruses. Pigs may be more easily infected and serve as a sort of “mixing vessel,” because they can also get infected with flu viruses from mammals, including pigs and humans. When two influenza viruses infect the same host (individual), they produce new descendants that may swap gene segments at random as they’re being produced, resulting in many different combinations. Some of them, as a result, just happen to have the right combination of genes to infect other species (like humans) that the parent viruses couldn’t infect.

This particular  ”triple reassortant” we’ve been hearing about as the ancestor of this virus was first identified over 10 years ago, in U.S. pigs, and has been in swine for at least the last decade.

Lynda in Texas asks: Will the pneumonia shot help with a secondary infection from H1N1?

Professor Morse: Yes. This shot protects against a type of bacterial pneumonia that used to be a major secondary infection, and a common cause of death in those elderly who had serious medical conditions. This vaccine prevents “pneumococcal pneumonia”, caused by a particular species of bacteria that is very common in the human population and has been a real killer in the past. So it will help. However, there are other causes of secondary infection that are not covered by the vaccine, so call your doctor if you get the flu and don’t start improving in a few days, or if you think you might have a secondary infection.

Spirit in New York asks: How concerned should I be about traveling on the subway, bus or train to another state? Is public transportation safe?

Professor Morse: No reason to worry at this time. There isn’t much risk from public transportation within the U.S., and that’s not likely to change until the flu becomes much more widespread. As of now, the virus is simply not widespread enough and there are not enough cases to make public transportation a major concern for infection. Public transportation, in general, is probably about the same risk as most places where people gather for similar periods of time.

Gerald in Connecticut asks: Our daughter is scheduled to leave for Mexico this Saturday on her honeymoon. Would you recommend she not go?

Professor Morse: This is really a personal choice, and I can empathize with her dilemma.

The CDC (Centers for Disease Control & Prevention) recommends avoiding all non-essential travel to Mexico if possible. Additional information and the latest updates are on the CDC Web site. 

The risk is probably very small, but the newlyweds may well enjoy their honeymoon more if they aren’t distracted by the concerns about catching the flu. If your they do decide to go, they should check on their transportation arrangements. Many U.S. airlines are still flying to Mexico, but with reduced schedules because there are fewer passengers. Most airlines appear willing to give refunds or cfredits for those who want to delay the trip.

Aside from Mexico, travel restrictions to other places are generally not warranted at this time. There is a natural tendency to want to close borders or limit travel everywhere when these disease reports come up, but restrictions are often too late, after the disease has already spread into the country. By then, travel restrictions are usually too late to really prevent spread.

Nathan in California asks: Is it possible there will be an increased spread of the H1N1 virus later this year during flu season?

Professor Morse: Yes, it is possible, although truthfully we don’t know what it will do. Flu is notoriously hard to predict, so those of us who work with the virus have a healthy respect for its variety and unpredictability. The possibility of the virus coming back in another wave (possibly even causing more severe disease) later in the year is one possible scenario. But this is unpredictable, and that’s why it’s very important for epidemiologists and public health people to watch influenza activity carefully and be prepared to act appropriately if something happens. Keep watching the media for new developments.

Vernell in Texas asks: What can be done to prepare in advance of a possible return of the
disease in the fall?

Professor Morse: First, stay well informed in case there’s a major change or sudden development in the flu situation. If the situation is unusual, there may be special recommendations.

Otherwise, basically prepare the way you usually do for the flu. The hygiene measures we’re recommending — basics such as “respiratory etiquette” (covering coughs and sneezes), regular handwashing, staying away as much as possible from people sick with the flu, and staying home if you think you have the flu — will apply whatever happens. Call your doctor or health department information line immediately if you’re having difficulty breathing, feeling a lot sicker than you think you’d normally be with the flu, or if you start getting worse instead of better. You may want to have some extra supplies of food and other basics at home in case you have to stay in for a while.

A vaccine may be available by next fall, and you should seriously consider whether you want to take it. Your doctor can help with this decision.

Many people ask about antivirals, like “Tamiflu”. In general, these drugs can be lifesaving in severe cases if we give them fairly early in the course of disease (within the first 48 hours), but have relatively little benefit in mild or moderate flu (which will get better without medication). We don’t encourage these drugs for mild cases, because we’re concerned that wide use might cause more rapid development of viral resistance to the drug.

Wishing you good health!

Disclaimer: Stephen Morse provides information and informed opinion, not medical advice.