>> craig, congratulations. >> be thank you. >> host: i really, really enjoyed reading your book. it's a fascinating read, and, um, i have a million questions for you, and i think the next 60 minutes are going to just fly by. um, but let me start with the title. tinderbox. if you would, explain why you chose that title and, um, i'm going to have a follow-up question for you. but the title, it's intriguing because, you know, tinderbox, again, if you could explain briefly why you chose that title and how it applies to the hiv/aids epidemic. ..
>> host: i hear you say there is a tinderbox around the burled for the emergence of hiv/aids. >> guest: that is why it surprises people the most. and surprised me. the genetic scientist who gave a rough day to of when the epidemic starts. most of the world is what moss, there's not much a j.p. but other places it is incredibly destructive. to understand these categories allow us to to think what benefactors to keep the virus moving? what can we do to turn the whole world into wet moss? >> host: talking about where the epidemic originated, americans, not
the policy wonks, they believe is started been received and cisco '04 lawsuit angeles and new york which is the site of the cities from the cdc releasing 30 years ago. that to it was occurring among gay men. that was years after cameroon and the congo that led to the development and spread of hiv. how did that happen? how do you believe the epidemic started? commenting on colonialism and a trade routes comment delved deeper. that is fascinating.
there was a tinderbox but it was many years ago. let's go playback to the beginning. >> guest: the precursor is this a man virus that many types of guerrillas and apes have in a community of chimpanzees of southeastern camera route and had been there thousands of years. and probably made its way into the human population. humans catch the chimpanzees to eat them and they get to cut and the blood oozes into it and becomes a chevy. that happened many times but did not started epidemic.
first to need people in contact with other people. what is crucial of what is causing the deaths is you have the intrusion of colonialism that is not dense. but remote region you have quarters going through the jungle their most sparsely populated by the not very populated continent. it was probably a porter who carry ivory tusks, gear, guns for colonial masters. they come back to new trading stations on the rivers that have steamships
because the belgians and the french exploit the area to make money. you have the initial spark coming out of this area area, going to river, getting on the ship ship, getting on the city founded by the belgian colonialist to trade with the world to extract the resources to africa. leopold fell is the center of the epidemic. it stays there. 1900 to 1960 hiv probably exist only around leopoldville. then nader is when it hip moves out of the immediate area. then it goes to haiti.
because immediately after the belgians leave congo, there is amazing political destruction. society is on the verge of collapse. united nation bring sinn expatriate's from other countries to be technocrats, doctors, nurses , teachers. one of them contracts hip and flies back to haiti. every single strain they no contract in europe or the night is states is traced back to that single infection. >> host: is it an oversimplification that you suggest the educated class
is sent to the congo to keep them out of politics, then a group contract hiv and come back to haiti. in the book you say at the time haiti was a popular tourist destination for gay americans. that is probably how hiv moved from haiti into the game american population. is that accurate? oversimplification? it makes sense but not a theory that i have heard before. >> host. >> guest: it is hard to know the nature of the transmission. you are right. it is predominantly gay men. it could have been a gay man in port-au-prince a haitian
immigrant to south florida florida, the blood trade, a lot of blood for plasma was donated in haiti and planeloads made its way back to the united states matt for hemophiliacs. the moment is obscure but one of those three likely happened. also worth mentioning, by the time this moment happens , it would make its way into other parts of effort that and the world in eventually. haitian story has been controversial but maybe five or 10 years later but one
way or another hiv was big enough in the congo and connected the death eventually it would get out to. >> host: going back to sub-saharan africa, discuss the concept of the aids belt. i know you will talk about male circumcision. you talk a lot about that in the book and your co-author daniel halperin is a huge proponent. explained the aids belts and male circumcision and throw in the differences between the spread of the epidemic between kenya and uganda but i will let you explain that. it is your research.
>> guest: the question i asked most often, from the excerpt up to the could toss apiece i got 20 meadows saying if it gets there by the 20th century, is it take 80 years to get to the united states and europe? hiv spread wide the in the congo but not the explosive levels of the east africa or the gay community there are reasons for that. one matt time, in the congo boys are circumcised at birth or initiation ceremony
is without a license. that is a deep in ancient tradition for many societies like muslims. where that is 13, hiv never got beyond 3% because the foreskin is much more vulnerable to hiv than other parts of a man's body. so you have a persistent low level of simmering. as transport movements improving human movement is efficient then it goes to rwanda and uganda in those places manner not circumcised because they are from the different ethnic tradition. instead of nigeria, they came down the nile valley.
so millions of men are not circumcise. they do get the explosive spread. instead of one or 2% sometimes 20% of adults infection rate. look at a country like kenya one group circumcises i'm sorry, but does not retain the but everybody else does. so that a.j. be rate among kenya adults is a couple% but those that don't is about 20% to around lake victoria. at the center of learning the president's father is
from there, that explodes. in southern africa, all groups would circumcise 200 years ago but now the tradition is going into decline. some is sequestered is asian , modern life, being away from traditions. but you lose that among several ethnic groups and then they get the courageous hiv rates. to carry that forward a bill sex is a much more efficient way to spread the virus than vaginal or oral sex. so what you do get to in the seventies it 80's with the fast lane culture more than the heterosexual
counterparts. that is an efficient way to spread the virus as well. >> host: your book has been called commercial and the aids industrial complex that says your ideas are crazy. which those do you think they are talking about and why is it controversial? >> daniel halperin and i had thousands of conversations over many years. we've would say there is something for everybody to pay. on the left, if you believe it could be told with the discussion of poverty, poor
health care and remedy is testing and condoms, that is not the whole story. of the right, believing about abstinence marital values, not to the whole story. aids is the most politicized epidemic of the growth having to do with the age that we live in. people yell at each other on tv or over facebook. with illegal drug use, the death, the sad truth is not curable and many years, not treatable, the stakes are very high. we've right by the time the epidemic is discovered it plans in the middle of
culture for common gay people are fighting for their rights and recognition , that intensity made it hard for a consistently cool headed look at the fax at the time. we hope the book delivers on the promise that the only thing that matters is to move the story to get right so the response is better. >> host: i am very familiar with daniel and now your work. you mentioned ted green and others, a harvard
researcher. working in the bush industry should come and interesting that those that were on the for the straight working on and 88 adored daniel halperin and ted green green, jewish educated liberal and ted said personally that i am a left-wing liberal never voted for a single republican but yet they are the darlings of the conservatives in the administration because they were talking about that abc but ignored ted and danielle talking about a comprehensive approach. so vague abstinence in the content side fighting and "b" was the forgotten child.
i have no problem with abstinence or condom promotion but not exclusively as you point* out do the trick. "b" is important especially in uganda and explained that. to think that the president was obsessed with abstinence with the christian evangelical background but it was the p faithful that you argue that is responsible for the decline. people got scared come with the president was speaking, and a decline. talk about that.
it is an important part of the book "tinderbox" one of the most amazing factors of the story is it is spread predominantly about sex. people don't want to talk about sexual behavior. , it is clear it is the transmission mechanism. very steadies early of how the behavior related to the efficiency of the pathogen. because of sex, people are deeply uncomfortable especially cross culture to talk to other people parts of the world about sexual behavior. africans do not have that hate up. begin 1986 in uganda much
earlier and more forcefully they get the memo aids is fatal, incurable, the spread by sex, and no vaccine on the horizon. drug czar not coming soon. political leaders and they get together to say what can we do to save our mothers and fathers and brothers and sisters and sons and daughters? they talk about behavior. uganda had polygamy as a standard. by the time that eighties roller around it is still the go. there are quite a few
marriages around the country. but it was of modern period where the bet had a wife and a girlfriend. the woman had a husband and a boyfriend. you can then do this they had a campaign called o greasing. stick with european partner. it is a funny term one paygo it is stake to and from the rubble stead increases in the spot it looks like a circle because they can only go so far. even in a polygamous marriage as long as it was
within the homestead. they sought an extraordinary decline over the course of five years if the average number of sexual partners. if the average number was 1.8 and a move down at a 1.5 , it had an extraordinary effect of the networks of sexual attraction. looking at the spread of new cases goes up through 1989. then if they miss senior dies of aids and sings about a publicly then new infections go off a cliff. the clearest case is uganda
and we found similar moments in the congo, zimbabwe, but not so organized but seniors, the religious leaders, the politicians talk about aids and not necessarily about a disease of the underlying causes you do see extra gear declines of hiv. >> host: that seems like cheap intervention. mentioning colonialism, the expansion of european countries into sub-saharan africa that is needed for the epidemic to live. also critical fast forward to the early 2000's.
you are certainly not suggesting that europeans are others go into sub-saharan africa, or maybe you are. [laughter] or we should not be a part of the solution but to refer to solutions negative three. -- negatively. explained to me a cheap intervention and it works. high level leadership leadership, menacing nursing gained, what do we take from at and why are you critical of the western response? >> guest: it is hard as americans to perceive us as
others do. it is a revelation would move to south africa in 2004. people could not be more wonderful to us. but they felt pushed around by the u.s. government especially politics. maybe it is part of our detour but for us to the and in a place and not take over. africans have a lot to say almost everyone says i say this but people don't listen. the western response has been massive and wonderful
wonderful, when i think of my tax dollars, i am glad they keep people live with aids drugs. more than other things. people come back from the dead, checking into a hospice because of the government providing medication, it is hard to feel bad about that. we struggle to be effective on prevention. not 100% disaster but the government has underwritten programs with did you are infected from giving it to their babies. that is good.
but it is consistently hard for the u.s. government and throwing u.n. aids into the pot, bill and melinda gates foundation doing wonderful for a call so, but it is difficult to see the disease the way africans to. to bring their own ideas and agendas to the problem but we talk about condoms. africans are not debating that to. that was here but the policy is transmitted through giant program putting policy on the ground. that is not the best policy. best would be clears finance
pepfar created to remove the bush should minister shouldn't aimed to put 2 million people and treatment and prevent 7 billion infections. no arguing 2 billion have been treated but the math gets fuzzier with preventing 7 billion infections. is it even possible to state such a goal that enables us to determine with our western response meet the goals? 80q say look at preventiopreventio n but also is there a better way? >> >> guest: there is a lot of new ways a statistically
with the data points. it is hard to figure out one intervention leads to one infection. it is more important the interventions be on point* as possible to their root causes of the epidemic's spread. i was amazed while traveling in africa how peculiar africans were aware of the death and destruction of the aids epidemic spread by sex but not aware the forces that made them more vulnerable.
not everywhere. in uganda they had gone better messaging. but i can recall many times you sit on the plastic year creaked in their yard and i applaud talk to people about aids and their sex life. i would hear it is terrible. i can remember as they died. horrible. but yet to was there clarity fair versus actual "decision points" to be made it aside
never having sex again. that what happened. a close african friend took psi johannesburg and he introduced me to a woman he was thinking about burying and later on he introduced me to a couple of other women who were his girlfriend. i am glad flip my notebook upside-down. this is you. these are the three winded you were sleeping with. then i look good job branch of those are the men that they are sleeping with them people say they get
startled. you bd i am sleeping with this guy? right. there is a network. if you have more than one sexual partner, you are more vulnerable and a bigger chance you will die or give the virus to somebody else. definitely the beginning of a conversation but at that point* we could put billions of dollars into aids prevention over 20 years and people did not know that is astonishing. and a tragic. it seems what we've zero
most people living with the horrible human catastrophe is the information they need to protect themselves. we have not done a good job of that. >> host: that is a good segue. described generalized and concentrated epidemics. also why you think smart people get the difference between generalized and concentrated and you have to have a different response? i would hope you would talk about baht's one or thailand but before that i pulled quotes out from the book but the one nephews is one that daniel halperin supervisors said i know when to hear
another thing about abc. agreed to condoms. do you want to tell me who? >> i should not. that is an attitude. i suspect that is a smart person they should know there is the difference so tell those people what the differences why it has to be dramatically different. >> some of this stuff is easier to understand in 2012 they and 1982. we have had the benefit of time. we are latecomers. but of what of water is under the bridge. reversed couple of decades
people made bets in their hearts of what they thought legwork. look at the secretion of with faith based promotion. , the id late to this story is a huge benefit because you can see brothers go off track. hiv and a lot of places spreads in concentrated phrase like thailand. by year the nineties by asian standards has a bad epidemic.
happening in brothels or intravenous drug use. most likely the sexual workers and the government is the most aggressive in the world to require clinton use. if hiv is spreading and relative handful of places and you can block it come with that is an easy intervention. in parts of africa with hiv widespread, not so much prostitution, although a factor, but it said the everyday life. been having a wife and a
girlfriend and the full bid having a husband and a boyfriend who pays for help with the children. you have a broader network. glancing at a distance the condo works. but actual experience has been countries with the highest rates the reported condom usage rate is higher than 80 rare in the world but they're used with prostitutes in the one nightstand. almost never used between husbands and wives. people to want to have children.
even in the bad epidemic areas, why aren't using them? we did at first but after a few weeks i trust him. it is intimacy. that would resonate almost every where. that is not generally the case people use them with their regular partners over decades. that is how you drive up for interactions but not others. condom use is useful but not the magic bullet. >> as you know, , a 2 billion people on treatment come obama increased the goal from
2 billion by 6 million. is a laudable increase. still not nearly enough. but yet to you suggest it is not sustainable? why is that? ic agree agree their response of those involved is i feel good about my tax dollars going to this. in fact,, the red knight added to those conversations if they did far enough, if i work for president bush is not a good reaction but working on a diet get a good reaction. but it is not sustainable?
why is the treatment component of pepfar not sustainable? >> guest: not sustainable but to keep people of the drugs, we could expand the numbers and decent amount. talk about $15 billion with seconds of losses in the financial collapse. not talking about a truly massive amounts of money, the problem is imagine a bathtub. you never heard trade it. the water overflows. it is a group of four but if we don't close the spigot of
new infections may cannot make fewer people get it tomorrow than today. first of all, it is bad for those people. is miraculous but not a substitute. the old the bad deigned about the drug's intervention is if they commit the expense of useful and effective prevention. people argue if it works out that way. but when people sit in their office, they have to make decisions. we have this much money.
80% drugs? 90%? now circumcision which the government spends money on. how much is left over for prevention, but family-planning, clean water , child and maternal health? there is a problem of finite resources. negative like to treat every last person of h.j. be we have to figure out to drive the best science and resources that money can buy to prevent the next 1 billion infections.
>> host: you talk about u.n. aids. they have a steady -- study by a note an apology if i don't get the translation but treatment is prevented. that is still in sub-saharan africa that arc goes like this. this is the argument. if you do treatment is prevention than the members go away and u-turn the quarter to spend less. do you buy that argument? it is based on science to suggest in response to your concern to put everybody on anti-retrofire role therapy me only half to get to this point* as opposed to higher
point* because treatment is prevention t-bond. >> guest: if there is some truth to that. those who have well treated infection are less likely e to transmit to others. if someone that is at high risk such as a sexual worker on a low dose of drugs they are less likely. or if your husband or wife, with a god. i know what 81 toothache imm down on any of these but there are problems with the strategy potentially. in the first few weeks after you are infected there is the thank you infection
face. if i got it today my viral load goes through the roof and goes down over the years. then when ibm unusually infectious i would not even test positive. how often do you test? once a week, the month, the rest of your life? one of the things that makes people change their behavior is fear. there is a lot of evidence that have the most effective and successful treatment programs, new cases are not going down that fast.
daniel halperin compares it to spf of 50 some block rival late in the sun all day. with the seat belts and air bags i am more likely to drive fast. well there is a reason to be cautious optimistic that more treatment means less infection, before the bet on that at the expense of others i would like to see it work. in a society massive investments lead to a drop of a long bull alliance of society to change sexual behavior. don't forget to the root cause.
don't take our eyes off of what has already been proven to work. >> host: mentioning fear fear, some of the desk -- experts fear this not prevention began we see evidence in the '80s friends watching friends die caused fear of rich caused behavior change. b.c. that in africa. some of those people that were critical of the year we see they give the impression the epidemic is worse and the world is a "tinderbox"
why but it organization and do that? and in some cases be wrong by 100%? >> guest: talk about u.n. aids. these are not a bad people. they were motivated to get to. >> host: he was one of the first people. >> guest: yes. to describe the extent and africa. they have worked very hard. god bless them. but i do think but in trying to raise the alarm politically about the severity of the epidemic come with the dated crept down.
hiv is hard to track. you get it today but don't show it to nine years later later, not like the flute or cholera. but in the nineties the estimates of the cases were overestimated. so then you hear talk about 45 million cases and it gets worse every over all the time. only starting around 2003 would better science comes in. and it starts to do rigorous simply like a census bureau going shanty to shanty to
test people. with that more progress methodology is applied kumbaya suddenly it is over estimated and they're off by half of the previous estimate id kenya. late 2007 u.n. aids gave then it and say there is not 40 million people it is 33. a lot of scientists feel they were slow to pick that up been there could have been political motives.
but people's passion and the vendor shall at at u.n. aids slow to realize the epidemic was less big and more narrow in what they portrayed. my friends say who cares 32 or 42 billion? and tell the kids get drugs to all of them but the counter argument is if you cannot render with some precision british is worse or getting better, it is difficult to have useful lessons and the inability of u.n. aids to ratchet down those numbers earlier made it harder as a society is with a j.p. anders circumcised.
science, precision, other. matters and makes it easier for everybody else to try the right -- draw the right conclusion. >> host: sometimes slow on the uptake we do a disservice if we don't go back to circumcision. i don't know why anybody who would be assessed with that beyond reporting on the data. it has been there for decades. i must confess running the white house offense nationally i do very that -- i knew very little about this.
data existed from the '80s. i learned from my colleagues they said are you serious? we have known this since the '80s? why didn't the committee embrace that more fully on? >> guest: the relationship between circumcision and hiv spreading comes out of research from canadians and canyons did in the slums outside of nairobi. hiv but the sex workers was was 70 year 80% of the winded had h.j. the. what about the men that go to them? they gathered together a couple hundred and they were
flabbergasted to see the most important factor is a favor circumcised or not. v. uncircumcised men are eight times more likely to get hiv in the slum of nairobi that is great data. but not to uncomplicated. there is something about this ethnic group but the be a muslim bad. this is all sorts of things that was no reason the system. it would take a few years to get that data to be rigorous enough to act on it to from
the public can -- policy point* of view but by the bid 90's this conversation is over. people are made very uncomfortable. they don't believe it and who will be the advocate to argue to circumcise more men in africa? it is hard to imagine but now my a co-author and his co-workers in 2005 we have rigorous find gains to show circumcised men that are 70% less likely to get hiv. it is of wasted decade. ahead of u.n. aids talks about the science.
>> host: i will use a bad verb, and not to cut you off but we have one minute left. but summarize for those watching we're degree go from here? you have to brilliant paragraphs that say this is what we need to do. this is what we can do best. you have one minute. [laughter] >> guest: treat as many as we can. good. keep being infected mothers from giving it to their children. make male circumcision safe and vol3 don't be scared.
share this finance with africans and be on point*. >> host: and voluntary in the ec if they want it. keep talking about sexual behavior. don't be scared. share this finance with africans and be on point*. >> host: thank you. i enjoyed the interview and the book and encourage people to read it. it was the tip of the iceberg. >> guest: i cannot think you enough. thank you. . .