By Anna Pulley
By Erin Sherbert
By Chris Roberts
By Erin Sherbert
By Rachel Swan
By Joe Eskenazi
By Erin Sherbert
By Erin Sherbert
Starting at about 6:30 a.m. Thursday, I stared at Condoleezza Rice's glistening hair for an hour. I watched her implacable half-smile. I listened to the undulations of her soft, reedy voice. I began to feel weightless, unhinged. Then – thwoooop! – the force of her testimony transported me to Inside-Out World, the place where global events are inverted to make trivial, hairsplitting hindsight into vital drama, and earthshaking conflicts mundane.
In the real world, Iraqi medics gathered U.S. bodies from Fallujah streets as the rest of that country sunk toward terrorist-breeding chaos.
In Inside-Out World, America's attention remains riveted on the 9-11 Commission, which ought to be reserved for the History Channel, but instead dominates network programming.
In the real world, U.S. troops conducted live-fire drills next to the North Korean border; the American military commander in South Korea bragged to Congress that the United States could whup North Korea if its soldiers attacked; and the North Korean government responded with veiled threats of nuclear war.
In Inside-Out World, the 9-11 Commission parsed who might've, would've, should've done things slightly differently in advance of terrorist attacks.
There's a name for hiding behind fantasy in times of crisis: psychosis. Judging from the head-in-the-clouds attitude Americans seem to be taking toward world affairs, I'd say we've gone completely insane.
High-level meetings on the North Korean nuclear threat were held in San Francisco last Wednesday and Thursday among senior diplomats from the United States, Japan, and South Korea. No newspapers that I've been able to find carried the story. A State Department flack told me no information would be released prior to the talks, and journalists would not be told where the talks were being held. And, by the way, U.S. officials would not comment afterward.
Determined to lead myself, and SF Weekly readers, out of the Condi-mented Inside-Out World and back to some semblance of horrific reality, I headed to the Japanese Consulate, where a Japanese official was briefing Japanese journalists on the nuclear threat talks. A Japanese press officer told me there would be no translation. I speak no Japanese, but these are desperate times, requiring desperate measures. So I attended the press conference, determined to glean whatever reality I could find.
At about 10 minutes past the appointed time, the diplomat – whom I was told to identify only as "a government official" – entered the room, smoothed the front of his dark-blue suit coat, and sat at a table. Behind the official, three tourism posters depicted views of Mount Fuji. In front of him was a roomful of folding chairs, some filled by a dozen or so Japanese journalists, two wire service reporters, and myself.
The official, whose expression was at once sullen and kind, pulled a spiral-bound notebook from a black briefcase and began speaking softly, gazing first at the ceiling, then at a spot in the middle of his table, then, fleetingly, at the assembled Japanese press.
He was so quiet, his hands so still, and his shifting gaze so apparently pensive, that I was certain something was troubling him – regardless of what his words may have been.
A reporter sitting in front of me, whose hair was styled like Prime Minister Junichiro Koizumi's, asked a question. The diplomat smiled politely, then looked at the ceiling without saying a word.
"What does he see up there?" I thought. "Bombs falling from the sky?"
He let out a long sigh, then went silent again. After a near-lifelong 15-second silence, he looked at us, and his face lit up.
This seemed like an "Aha!" moment, which in my mind doesn't mix well with the threat of Armageddon.
The government official was a different man now; he uncrossed his arms and put both hands on his left knee, speaking animatedly, laughing almost. The government official's eyes darted to his legs, to the reporters' faces, to the rear wall, and back to the reporters again.
In a way, this change was pleasant. The new, amiable, raconteur of a government official seemed like a nicer guy to chat up at a bar than the previous sullen version. All the same, when it comes to watching Asian diplomats discussing the wiles of crazed North Korean dictators, I prefer serenity.
The Japanese journalists, who until then had been sitting placidly, began furiously scribbling in impeccable script as the government official pontificated in his newfound, animated style. After five minutes of this terrifying spectacle, the diplomat finished. His pleasant expression melted. His shoulders relaxed, and his forlorn gaze drifted to the floor.
The Japanese reporters chatted happily as they filed toward the elevator. Undistracted by the meaning of the diplomat's banter, I knew better. I wanted to duck and cover, under a chair.
In Inside-Out World last week, former U.S. Ambassador to the United Nations Richard Holbrooke held forth as a Fox News analyst qualified to parse Rice's testimony. Of course, he was qualified; Holbrooke had previously testified before the 9-11 Commission in closed session.
But back in the real world, Holbrooke had spent the previous Wednesday speaking before the Council on Foreign Relations about a threat far more serious than 9/11, in a hearing that was completely ignored by Inside-Out World news.
Holbrooke is famous among high-level diplomats for his penchant to engage in reality-speak. He fashioned the Dayton Peace Accords by dishing plain-spoken bons mots to intransigent politicians of the former Yugoslavia. And late last month, Holbrooke offered a dose of reality to San Francisco. He is now the chief executive of a group called Global Business Coalition on HIV/AIDS, an alliance of multinational firms dedicated to recruiting other corporations to help combat the disease.
Holbrooke has been trying to bring attention to a disheartening fact: Worldwide, 95 percent of people infected with HIV don't know it, thanks to the failure of global testing programs.
When he spoke last month, Holbrooke linked the absence of routine HIV testing, which has rendered the world's greatest scourge invisible, to social struggles emanating from San Francisco in the early 1980s.
"It is my conviction now, based on having worked on this problem for five years, that testing is the weak link in the chain to defeat HIV/AIDS. And it is a weak link for – because, not to put too fine a point on it, the United States, in an extreme example of ethnocentrism, exported to the rest of the world a battle that was waged in the streets of San Francisco in the mid-1980s. It was the Angels in America period. And the Reagan administration – and not just the Reagan administration, but President Reagan himself and members of his administration and people in public life at that time – said very publicly, and you all remember this, that the disease was God's punishment for people of a certain sexual orientation.
"And the result was that the gay community in San Francisco and New York went into the streets and went ballistic. And they won the war. Because they were right," said Holbrooke, who represents 140 companies in his new role. "As a result of that bizarre cultural event in American life, testing was going to henceforth always be confidential and, in most cases, voluntary."
At its most basic, Holbrooke's goal can be summed up as inserting the term "routine testing" where international HIV protocol now uses the term "voluntary testing." In a recent New York Times editorial, Holbrooke denounced the focus on voluntary testing as "ethnocentric Western rhetoric, born in the 1980's in the United States under different circumstances."
HIV testing, Holbrooke believes, should be required at marriage, before childbirth, and during any hospital visit.
There exist two extremes in the world of public-health approaches to HIV. There's the U.S. approach, evolved from the 1980s San Francisco human rights struggles, in which a large network of public and nongovernmental AIDS organizations seeks ways to combat the disease that are mindful of privacy, individual freedom of choice, and the potential for discrimination. The San Francisco AIDS Foundation, for instance, does not directly recommend on its Web site that individuals submit to HIV testing. Rather, the foundation recommends that people make an informed choice, considering the advantages and disadvantages of being tested, which, the group informs readers, include possible discrimination by insurance companies.
The other extreme is Cuba, where, a decade ago, I researched and wrote a series of stories on the country's health care system. I remember dining with a Swiss physician who worked with an international health-related nonprofit group and the director of cancer surgery at a Havana hospital, at the surgery director's home.
The two doctors discussed the pros and cons of the Cuban approach to HIV, which involved widespread, compulsory testing of people deemed at risk of HIV exposure due to their travel or sexual histories. The government then quarantined those who tested positive; once quarantined, physicians interrogated patients about their previous sexual partners, who were in turn tested.
According to a 2003 article in the Journal of the American Medical Association, Cuba's approach was also different from America's in a more palatable way: In 1986 alone, the government invested $3 million in testing equipment. By 1993, 12 million tests had been conducted in a country with 11 million citizens. By the 1990s, the country was devoting $15 million to $20 million a year to anti-viral drug therapy, intensive medical care, and food and housing for quarantined patients. In 2002 the Cuban government reported an HIV infection rate of .03 percent, less than one-tenth the level of the United States; it was a figure the JAMA article said international health organizations had endorsed.
Cuba has held the line on the spread of HIV despite its global renown as a sex tourism destination. The world's other sex-tourism capital, Thailand, is rife with HIV/AIDS. Cuba is the only country with this kind of success. It's the only country in the world to take such draconian steps. Yet it's not held up in AIDS forums as a global model for HIV containment.
I should emphasize that neither Holbrooke nor his organization advocates a Cuban approach. Nor would I advocate totalitarianism of the Cuban stripe. But Holbrooke is attempting to draw attention to the possibility of a praiseworthy third way, in which saving lives in countries where millions of people are threatened by HIV takes precedence over a preoccupation with individual choice.
To get a better sense of San Francisco's historical role in the current global AIDS testing crisis, I called Trevor Neilson, executive director of Holbrooke's Global Business Coalition on HIV/AIDS, and asked him if the San Francisco legacy of the insistence that AIDS tests be confidential and voluntary is really as bad as Holbrooke says. Neilson noted that I was calling on the 14th anniversary of the death of Ryan White, the 13-year-old who contracted HIV from a blood transfusion, then had to sue officials in Kokomo, Ind., to be able to attend public school.
"The Reagan administration was openly hostile to addressing the issue, and openly hostile to the groups traditionally associated with the issue, which meant the gay community," Neilson said. "That did lead to a climate of fear. In a climate of fear, there are very few people who are willing to step forward and be tested. They are afraid of the repercussions."
As the disease progressed amid an atmosphere of discrimination, efforts to encourage widespread testing were also hindered because there was no effective treatment for the disease, and thus no self-interested reason for people to find out if they harbored the virus. So the testing ethos that emerged from HIV/AIDS's early days in San Francisco and New York focused on civil liberties. As Africa is sundered by the disease – and with statistics showing that India will likely be the next country devastated by the epidemic – the emphasis should shift to public health.
"San Francisco led the world in battling – and continues to lead the world in battling – the most deadly disease of all time. But the initial notions of how to address the epidemic 20 years ago obviously need to evolve, particularly now that we have access to drugs," Neilson said. "We need to adjust the way we look at testing."
To get another perspective on the testing dilemma, I called a publicist who had just moved from a San Francisco AIDS group to a New York AIDS nonprofit. She recommended I speak with someone from a third AIDS group, where I was sent to a fourth, the San Francisco AIDS Foundation, which pioneered testing back in the 1980s. The SFAF does not currently focus on testing, a spokesman told me, and it would be best if I spoke to another group.
The silence is typical, Neilson said. Testing dredges up touchy issues many groups would rather not address.
"For leaders in the AIDS community in San Francisco, their involvement in the testing issue globally would be very useful. They're the ones who were involved back when it was happening. They should be speaking to the WHO, to UNAIDS, to the global decision-makers on this issue, giving their assessment of what the best way to address the lack of access to testing would be," Neilson said. "They have two decades of experience in this issue. It might inject a dose of reality on the difference between 1980s San Francisco and modern Botswana."
It might also help rescue some of us from Inside-Out World, so we start paying attention to the planet's real problems again.