Zambia

Under helgen pågår Hosoi Festival på Slakthusområdet i Stockholm. Influenser från Finland, Indonesien och Zambia präglade invigningskvällen. Det är en festival som lyfter fram musik som ligger långt bortom topplistorna, skriver Magnus Säll.

Tony Gustavsson, 50, fick jubla sent i en galen målfest.  Australien vände underläge 2–5 till seger med 6–5 mot Zambia. Michelle Heyman blev stor hjälte – när hon gjorde mål i matchens sista ordinarie minut.  – Jösses, vilken föreställning det här blev. Elva mål i en osannolik match, säger kommentatorn Mats Lilja i Eurosport.

Sveriges fotbollsdamer står inför tuffa EM-kvalmatcher mot Frankrike och England. Stjärnan Fridolina Rolfö ansluter till truppsamlingen efter att nyligen ha gjort en minnesvärd resa till Zambia. – Det är häftigt vad fotboll har för påverkan på människor, säger hon.

Kolerafallen sköt i höjden under förra året, enligt preliminära uppgifter från WHO. Totalt registrerades över 4 000 dödsfall och 667 000 smittfall globalt, rapporterar The Guardian. Kolerafallen har ökat i världen sedan 2021 och 2023 års siffror var betydligt högre än året innan. WHO klassificerar den globala återväxten av kolera som en nödsituation av grad 3 – organisationens högsta interna hälsokris. Utbrotten var klart dödligast i Malawi och Haiti, där antalet dödsfall nådde 1 771 respektive 1 156, vilket gör det till det värsta utbrottet i Malawis historia. – Den aldrig tidigare skådade frekvensen av fall och dödsfall är ytterst skräckinjagande och helt överväldigande för hälsosystemen i dessa länder, säger Machinda Marongwe, programchef för Oxfam i södra Afrika. – Utbrottet eskalerar i en okontrollerbar hälsokris, fortsätter Marongwe. Skolor stängs – folk flyttar Minst 30 andra länder har rapporterat kolerafall sedan början av 2024, skriver The Guardian. Zambia har rapporterat 7 500 nya fall sedan oktober och 500 nya fall och 17 dödsfall på bara 24 timmar under förra veckan. Zambias president, Hakainde Hichilema, har uppmanat människor att flytta från städerna och tillbaka till landsbygden – och skolor förblir stängda för att förhindra ytterligare spridning. Minst tre personer har avlidit i samband ett våldsamt utbrott i norra Moçambique under förra veckan, då upprörda invånare brände byggnader under anklagelser om att regeringen medvetet hade spridit sjukdomen. Vaccinbrist till 2025 Med tanke på spridningen av utbrottet till nya länder och den globala bristen på koleravaccin uppger WHO att risknivån för kolera bedöms fortsatt vara ”mycket hög”, skriver The Guardian. Den globala bristen på vaccin väntas pågå åtminstone till 2025. Kolera är en akut diarrésjukdom som sprids via förorenat dricksvatten och som kan döda inom några timmar om den inte behandlas. Dödligheten är extra hög bland barn och särskilt hos barn under fem år.

▸ Fler än 30 personer tros ha blivit instängda efter ett ras i en gruva i Zambia.

Bara under 2020-talet har det skett nio kupper i Afrika – det är en tredjedel av alla de lyckade kupperna på kontinenten sedan århundradets början. Det är symtom på en bredare politisk kris, skriver The Economist och hänvisar till mätningar som visar att acceptansen för militärstyre har ökat i 24 av 30 afrikanska länder sedan 2014. Yngre afrikaner ses ofta som en latent progressiv kraft – men de är inte mer immuna mot populism än amerikaner är mot Donald Trump, skriver tidningen. De unga kommer att dras till de som erbjuder en förändring för dem, om demokratin inte ser ut att göra det. Democracy is under threat from graft, stagnation and violence By The Economist 3 October 2023 For many years, coups in Africa seemed a thing of the past. But in the 2020s they are back with a vengeance: the nine this decade account for more than a third of successful African putsches this century. At this rate there will be more of them in the 2020s than in any decade since the 1960s. Aside from the latest one, in Gabon on August 30th, the seizures of power have been in the “coup belt”. It is possible, if inadvisable, to walk some 6,000km from the Atlantic coast of west Africa to the shore of the Red Sea and stride only through countries where there have been coups in the past three years (see map). The trek from Guinea to Sudan would cross the Sahel, the region south of the Sahara where there have been two coups each in Mali and Burkina Faso since August 2020, and one in Niger in July. Africa—which covers an area larger than America, China, India, Japan and western Europe combined—is more than its coup belt. Yet the takeovers are part of a broader political crisis. The most recent surveys by Afrobarometer, a pollster, find that in 24 of 30 countries approval of the idea of military rule has risen since 2014. Contingent support is higher. On average across 36 countries more Africans (53%) would be willing to consider a military government than would rule it out (42%) “if elected officials abused their power”—which they often do (see chart 1). Just 38% expressed satisfaction with “democracy”, the lowest share since at least 2014. The backing for potential strongmen or deep dissatisfaction with democracy was common across the coup belt, but also in relatively stable places, including Botswana and South Africa (see chart 2). Afropopulism, for want of a better phrase, is an increasingly potent force. Why is there such widespread discontent? Africans are frustrated with the sham that passes for “democracy” in most countries. They are also fed up with flimsy states that provide neither security nor prosperity. Around two-thirds of them, as well as majorities in 28 of 36 polled countries, feel their countries are heading in the wrong direction. Should this continue, many Africans, especially younger ones, may be tempted to reconsider shabby social contracts—and look for radical change. The most important failure is the provision of security. African states are often strong in areas where they ought to be weak and weak where they ought to be strong. Many regimes are adept at beating or locking up opponents, but inept at stopping their citizens from being robbed or killed. As a consequence, those promising to restore security, however ruthlessly, can gain support from ordinary citizens. Although some African wars in the late 20th century were much deadlier, the overall number of African conflicts is rising, according to a paper published last year by the Peace Research Institute Oslo. It noted that small conflicts caused more deaths in 2021 than at any point since its data began in 1989. The number of conflicts in which at least one side is a state was higher in 2021 than a decade earlier. Since 2021 things have become only bloodier. In Burkina Faso, Mali and Niger, a trio of countries where jihadists linked to al-Qaeda and Islamic State run riot, deaths in conflict have risen from under 800 in 2016 to over 10,000 in 2022. It is no coincidence that all three have gone from being largely democratic to suffering coups in the 2020s. Putschists have sought to justify their takeovers and gained support by pointing to insecurity under democracy. As the jihadist chaos spills into coastal states, political chaos could follow. Togo, for example, has a dynastic dictatorship like the one recently toppled in Gabon: the Gnassingbé family has run the country for 56 years. And it faces growing jihadist insecurity—at least 140 people have been killed since July 2022. In Nigeria, Africa’s most populous country, jihadists terrorise the north-east, gangs kidnap hundreds at a time in the north-west and armed separatists pillage the south-east. Clashes between farmers and herders in the centre add to the bloodshed. More than 10,000 people died in conflict in the country in both of 2021 and 2022. This year will be almost as bad. acled, a conflict-tracking group, rates Nigeria as having the fifth-most extreme violence globally, behind Ukraine. Nigeria’s political class, lounging in well-guarded mansions, is out of touch. Turnout in this year’s election was 29%, the lowest ever. More than 40% of Nigerians think it would be legitimate for the armed forces to take over in the event of abuses of power by elected leaders. Before the election senior Nigerian political figures told The Economist they had heard of coup-plotting. That is a troubling development, given that the country was run (abysmally) by military dictators for much of the second half of the 20th century. Other large countries are riven with conflict. Though the civil war centred on Ethiopia’s Tigray region may be over, clashes in Amhara and Oromia spiral on. Resurgent violence in the east of Congo has caused almost 3m people to flee from their homes since March 2022. In April 2023 Sudan plunged into civil war. All three countries are among Africa’s ten most populous. In every place people will seek protection where they think they can find it. Insecurity is felt beyond war zones. In a poll of 30 countries around the world released last month by Open Society Foundations, an NGO network, four of the five countries with the highest share of respondents fearing political violence were African: Kenya, Nigeria, Senegal and South Africa. The latter’s murder rate, among the highest in the world, is rising again. Lawlessness increases support for populists and vigilantes. And 72% of South Africans would swap elected governments for a crime-bashing strongman. One former cabinet minister, who campaigned against apartheid, praises Paul Kagame for Rwanda’s apparent lack of crime (but says less about its abuses of human rights). “Kagame has the right idea: sometimes you need to crack the whip.” Economic stagnation compounds the political crisis. From 1990 to 2018 the number of people living in extreme poverty in sub-Saharan Africa rose from 284m to 433m, as population growth often outstripped the economic sort. The region has lost another decade: real gdp per person was lower in 2022 than ten years earlier. Households and governments are also facing a tightening financial squeeze. The median inflation rate in sub-Saharan Africa has more than doubled since the start of the pandemic. In a region where food makes up 40% of consumption, there is double-digit food-price inflation in 80% of countries. Some 17% of government revenues will be spent on servicing external debt this year, the highest share since 1999. “Job creation” is by far the most-cited priority by 18- to 35-year-olds in Afrobarometer polls. The Mo Ibrahim Foundation, a British NGO, reckons that 18m formal jobs must be created annually to absorb the numbers entering the labour force; the current figure is 3m. Almost half of 18- to 24-year-olds in 15 countries surveyed last year by the Africa Youth Survey, a poll by a South African charity, said they were thinking of emigrating. Young Nigerians talk of “adulthood na scam” and hunt ways to japa, Yoruba slang for to emigrate. Earlier this year Hakainde Hichilema, whom the West sees as a rare liberal on the continent, warned his outside champions that African democrats need to secure material results or they will face political consequences. “[Y]ou can’t eat democracy,” argued Zambia’s president in an opinion piece urging foreign creditors to speed up debt restructuring. “Human rights may sustain the spirit, but not the body.” The desperation to meet basic needs partly explains why Africans may be relatively willing to consider strongmen. The Open Society poll asked whether authoritarians would produce better results in ten policy areas, such as creating jobs and fighting crime. In eight cases the sub-Saharan African average was higher than the global one. “Invariably, juntas that promise better material conditions will show up and win enough people’s hearts and minds,” notes Ken Opalo of Georgetown University in America. Nevertheless, Africans’ faith in what passes for democracy is plummeting not just because of the insecurity and poverty their governments deliver, but also because of the nature of politics itself. In the 1990s and 2000s most African countries ditched one-party systems and embraced multi-party elections. The pageantry of elections, however, obscures the fact that much of Africa has only the patina of democracy. EIU our sister outfit, classifies just one African country (Mauritius) as a “full democracy” and six as “flawed”. Between 1990 and 2019 sitting presidents won 88% of the 112 elections they ran in. Nine leaders have kept power for more than 20 years. These include Uganda’s Yoweri Museveni; Cameroon’s Paul Biya, who spends much of the year in a Swiss hotel; Equatorial Guinea’s Teodoro Obiang, the longest-serving president of any country; and Mr Kagame. All fear fair elections; all may be grooming a son for office. Even relative newbies abuse the law, entrenching frustration. In August Zimbabwe’s main opposition party did not contest yet another dubious election because it sees the courts as biased. A month earlier the Central African Republic’s president won a referendum he rammed through the courts that will end term limits. In 2020 Alassane Ouattara, president of Ivory Coast, won a third term after controversially tweaking the constitution so he could get around the two-term limit. Senegal’s Macky Sall this year opted against a similar move after violent protests. But any goodwill earned was undermined by the arrest of hundreds of opposition-party members, including a presidential candidate. On average in Afrobarometer polls only 13% believe that no one in their country’s presidency is corrupt. Transparency International (TI), a watchdog, finds that sub-Saharan African countries are on average seen as less clean than El Salvador, where graft is so endemic that a millennial authoritarian has promised to build a huge jail specially for white-collar criminals. On average, perceptions of corruption in sub-Saharan Africa were slightly worse in 2022 than they were a decade earlier, reckons TI. The Open Society poll found that corruption was the gravest national issue for voters in Ghana and Nigeria. Voters also fret about it in South Africa, where “state capture” became ubiquitous under Jacob Zuma, president from 2009 to 2018. The looting of state institutions remains a problem in South Africa today—and in many other countries. “The capture of democratic political systems by private power networks is arguably the greatest threat to civil liberties and inclusive development in Africa,” argues Nic Cheeseman of the University of Birmingham in Britain. Putschists exploit anger at graft—and it works, at least initially. In a poll before the first coup in Mali, 58% of people thought most or all the people in the presidency were corrupt. Two years and a second coup later, just 25% did. In Guinea the share before the coup was almost 50%. After it the share fell to 28%. Why doesn’t dissatisfaction with sham democracy spur Africans to try to obtain a better version of it? There are several reasons. For a start it is fiendishly difficult to oppose dictatorships. The bad guys usually have the guns. Ruling parties also often co-opt NGOs and youth groups. Many activists have tried to improve democracy and to vote out authoritarians. Yet after decades of failing, some may be concluding that only more radical methods, even coups, can end stagnation and state capture. Guinea’s main opposition leader, for example, told The Economist of his “relief” immediately after the coup that ousted Alpha Condé, then president, in 2021. Second, there is reason to believe that support for liberal democracy is softer than its champions would wish. In Mali, for example, support for the idea of military rule had been flat for years at just under 30% before the first coup. Now almost 80% of Malians say they approve or strongly approve of rule by military men. Although outsiders may point out that liberal democracy has never really been tried in Africa, that is not always the view of Africans. Last month Olusegun Obasanjo, a former Nigerian president, said: “We have seen that the liberal type of democracy as practised in the West will not work for us.” Mr Kagame has argued similarly. (“The West does not define democracy in Africa.”) In the Africa Youth Survey just 39% of respondents said that Africans should emulate “Western democracy”; 53% said Africa needed to find its own version. Indeed, too much is often expected of young Africans. Many of them are apathetic when confronted with the façade of democracy. They are more than twice as likely to say they did not vote in the last election as the over-56s. In Nigeria’s election this year young voters helped Peter Obi to the best-ever result for a third-party candidate but he still came only third. In South Africa’s last general election only 30% of eligible 20-somethings voted—from apartheid to apathy in a single generation. Support for military rule if elected leaders abuse power is highest among the young. On average 56% of 18- to 35-year-olds would contemplate it, versus 46% of those aged 56 and older. It is young men who rally in support after coups, complicating potential efforts by African countries or the West to reverse takeovers. Not that outsiders’ commitment to African democracy is especially strong—the third reason for its feebleness. The continental organisation, the African Union, is weak and ultimately the creature of its mostly authoritarian members. Regional hegemons such as South Africa carry less weight: economic stagnation means it has less hard power, while endorsing rigged elections in Zimbabwe and elsewhere means it has less soft power. Meanwhile, China skews aid towards corrupt autocratic regimes, as the Chinese Communist Party preaches its model to Africa’s ruling parties. Russia, whether through the notorious Wagner Group or via arms sales, props up juntas and authoritarians. Newer players such as Turkey and Gulf countries will not promote democratic norms. The West offers half-hearted help and hypocrisy. It sometimes speaks out when elections look sketchy, as was the case this year in Zimbabwe and Sierra Leone. But America decided to whitewash dodgy results in mineral-rich Congo in 2018. Britain is unlikely to criticise Mr Kagame given that it wants to fly asylum-seekers to Rwanda. France rails against coups in countries where it stands to lose influence, such as Niger, but says little when the putschists are in tune with Paris, as was the case with Chad’s coup in 2021. Françafrique—the term given to how France has maintained influence in former colonies by propping up autocratic elites—is coming back to bite Paris. In Mali a survey in 2021 found that more than a fifth of Malians believed that France’s armed forces in the country were in league with jihadists or separatists. In Burkina Faso the new president, 35-year-old Captain Ibrahim Traoré, says that he is restoring sovereignty. It is the free choice of his junta, like Mali’s, to ask Russia for help. After Niger’s coup, the junta quickly scapegoated France, which had troops fighting jihadists in the country. Crowds waved Russian flags and decapitated a rooster painted in French colours. In Senegal, protesters against Mr Sall’s flirtation with a third term burned down French-owned supermarkets and petrol stations. Half of Ivorians say that France is the country they trust least, according to Premise Data, a pollster. So long as Africans see—and experience—“democracy” as a charade played by corrupt elites with the help of foreigners, then many will consider other options. What those look like will vary depending on the context. In South Africa frustration at meagre progress since apartheid is opening up space for Julius Malema, a hard-left black nationalist, and for ethnic-based parties. In Nigeria the efforts of Nnamdi Kanu, a separatist, to resuscitate the dream of an independent Biafra rely on charisma, populism, disregard for the truth and violence. Elsewhere populist military men may prove appealing, at least temporarily. In Burkina Faso Captain Traoré chooses deliberately to mimic Thomas Sankara, a revered former socialist leader often referred to as Africa’s Che Guevara. He came to power in a coup in 1983 aged 33 before being gunned down four years later. France has been a butt of both men. There is a well-intentioned desire to see Africans, especially younger ones, as a latent progressive force. But it is also patronising to deny, given the present circumstances amid what passes for democracy on the continent, that many Africans will be tempted by authoritarians. They are no more immune to populism than Americans are to Donald Trump, or Turks are to Recep Tayyip Erdogan. They will gravitate to those who seem to meet their needs—or at least offer a change from those who manifestly do not. © 2023 The Economist Newspaper Limited. All rights reserved.

Edward Chilufya stod för båda målen när Häcken vann med 2–0 mot AIK. – En skön känsla. Jag har spelat så många gånger mot AIK och aldrig gjort mål förut, säger han enligt TT. Den 24-årige zambiern spelade tidigare flera säsonger för Djurgården utan att lyckas göra mål mot AIK. Nu blev det dubbelt upp i tredje matchen för Häcken, dit han lånats ut från danska klubben FC Midtjylland. De tre poängen var viktiga för Häcken som i och med segern hänger sig kvar i toppstriden. Malmö FF och Elfsborg ligger etta och tvåa på 52 respektive 51 poäng, dock båda med en match mindre spelad.

En 476 000 år gammal träkonstruktion har grävts fram i Zambia, rapporterar SVT Nyheter. Träkonstruktionen är den äldsta som hittills har hittats.

▸ En 476 000 år gammal träkonstruktion har grävts fram i Zambia, rapporterar SVT Nyheter.

Målet är att aids ska vara utrotat år 2030. De senaste årtiondena har antalet dödsfall i sjukdomen, orsakad av hiv-virus, minskat drastiskt. Men även om vetenskapen har gått framåt så återstår andra typer av utmaningar, skriver The Economist. Det finns medicin som minskar risken att smittas med omkring 99 procent. Men det finns andra problem kopplade till den typen av mediciner. För kvinnor i vissa länder där HIV är vanligt har det setts som ett tecken på att kvinnan inte litar på sin man, eller att hon planerar att vara otrogen. Istället för att ta en tablett varje dag kan man ta en spruta varannan månad. Men för den som inte har möjlighet till det finns ett simplare knep: att stoppa bomull i medicinburken så att mannen inte ska upptäcka den. The virus can be brought under control, but it’s complicated By The Economist September 17, 2023 How can cotton wool help in the fight against aids? The answer is surprising, and illuminates how complicated it will be to beat the deadliest sexually transmitted sickness of all time. The struggle involves not only dazzling science but also old-fashioned insights into human behaviour, rational and irrational. Many people who do not have hiv, the virus that causes aids, know they are at risk. They can take pre-exposure prophylaxis (prep), a kind of drug that reduces their chance of contracting it by 99% or so. This comes as a daily pill, and is popular among gay men in rich countries. However, there is a much larger group of people at high risk, for whom a daily pill is far from ideal: heterosexual women in poor places where hiv is still very common. If their boyfriends discover they are taking the pill, they may conclude that their girlfriend does not trust them, or that she is planning to cheat on them. And a depressing number of boyfriends who suspect such things react violently. A high-tech solution is on the horizon: cabotegravir, from ViiV Healthcare, a single injection that lasts for two months and is much more discreet than a daily pill. Alas, it is new, costly and not yet widely available, especially in Africa, where the virus is most widespread. So Patrick Mdletshe of the KwaZulu Natal Provincial Council on aids in South Africa offers a low-tech fix: stuff cotton wool in the bottle so the daily pills don’t rattle and your boyfriend won’t notice that you are taking them. Unaids, a un body, hopes to end aids as a major public-health threat by 2030, building on the staggering success of the past two decades. aids, which weakens the immune system, has killed about 40m people—more than covid-19. However, the pace at which people are dying of it has fallen dramatically. In the early 2000s it was 2m a year, largely in poor countries, where hardly anyone could afford $10,000 a year for life-prolonging pills. In some African countries between a fifth and quarter of the adult population was infected with hiv; nearly all were expected to die of it. Life expectancy in Zimbabwe and Eswatini fell by two decades. Aids slaughtered adults in their productive prime—slowly. Breadwinners sickened, stopped earning and needed care. Their spouses looked after them until they, too, fell ill. Daughters dropped out of school to care for ailing parents. Families were plunged into penury. Then the price of antiretroviral pills plummeted, as drug firms offered steep discounts for poor countries and donors chipped in billions to pay for them. Today a year’s supply can cost a mere $45. Between 2001 and 2019 life expectancy in sub-Saharan Africa rose by 17%—and much more in the worst-affected countries (see chart). Globally, some 21m deaths have been averted, by one estimate. Today, three-quarters of those infected—roughly 30m people—are receiving treatment. Unfortunately, triumph has bred complacency, argues Peter Sands, the head of the Global Fund to Fight aids, Tuberculosis and Malaria, a donor-financed body. “There’s a diminishing sense of urgency,” he says. Or worse. The biggest donor by far is America. Its global aids programme, pepfar, which was set up by President George W. Bush, expires on September 30th and some Republicans are trying to block its reauthorisation. A recent report from a conservative think-tank called aids “primarily a lifestyle disease” and griped that pepfar was being used to promote a “radical social agenda overseas”. (It does not bar aid recipients from talking about abortion.) Mr Bush is horrified. “To abandon our commitment now would forfeit two decades of unimaginable progress and raise further questions about the worth of America’s word,” he fumed in the Washington Post on September 13th. An estimated 39m people are hiv positive—more than half of them in Africa. All will need lifelong treatment, unless a cure is found. Meanwhile, the virus is still spreading. Some 1.3m people were freshly infected last year. In Eastern Europe and the Middle East, the numbers of new infections in 2022 were 49% and 61% higher than in 2010, albeit from low bases. There are two main approaches to tackling the virus. One is to invent new medicines: ideally a cure or an effective vaccine. The other is to reach more people with existing technology. Both approaches—in the lab and on the ground—are being pursued in tandem by governments, private companies, donors and ngos. A cure seems a long way off. A vaccine may be closer, but hiv is an elusive target. It is highly mutable, and hides its dna inside some of the immune cells that are supposed to destroy it. Nina Russell of the Gates Foundation, who has worked on hiv vaccines for “many, many, many, many” years, is nonetheless hopeful. Past failures have taught scientists that they need to design vaccines that can teach the body to make antibodies to tackle a wide range of viral strains. They might have to create three, four or five different vaccines and jab people with all of them, in the correct order. Firms such as Moderna and BioNTech are using mrna technology to speed up the process. However, even optimists do not expect success this decade. So hitting the 2030 target will depend largely on two things. First, finding and treating more infected people. Second, identifying those who are at risk of infection, and helping them avoid it. unaids urges countries to aim for “95-95-95”: where 95% of those who have the virus know they have it, 95% of those who know they have it are receiving treatment, and crucially that 95% of those in treatment are “virally suppressed”. If the drugs suppress the virus to a level where it is undetectable—and keep it there—it cannot be passed on sexually. If the world were to reach 95-95-95, the disease would be brought under control, unaids reckons, though tens of millions would still be living with it. In 2022 the figures were 86-76-71, a hefty improvement on 71-48-40 in 2015. But the “last mile” will be hard. “You have to be much more creative,” says Dr Quarraisha Abdool Karim of caprisa, a research centre in Durban. One enormous, tricky group is men. They are less likely to get tested than women, not least because they do not get pregnant. Prenatal clinics are a wonderfully convenient place to test women who have recently had unprotected sex. If they test positive, many countries now offer them free drugs, which protect mother, child and future romantic partners. There is no male equivalent of a prenatal clinic. Also, some men have a macho reluctance to seek medical help. They “get very sick before they get tested”, says Sibongile Tshabalala, the chair of the Treatment Action Campaign, an ngo in South Africa. “As men, we’re embarrassed to go to a clinic. We’re taught we need to be strong, so we cannot be seen to be sick,” says Ronnie Sibisi, a 60-year-old from Vosloorus, a township near Johannesburg. He was “a player” with many girlfriends, he says. He knew how the virus was transmitted, but seldom used condoms. “I didn’t think about it,” he shrugs. He did not get tested until he collapsed and woke up in hospital. It is, perhaps, most crucial to reach young women and girls. In sub-Saharan Africa hiv is three times more common among females aged 15-24 than among their male peers. This is because older men often seek younger partners. There is peer pressure on young women to have trendy clothes and hairstyles, says Ms Tshabalala. These cost money, which impels some girls to sleep with older men. And only 36% of young women in eastern and southern Africa report having used a condom the last time they had sex with a casual partner. In West Africa it is only 25%. If their “sugar daddies” infect them, the girls may pass the virus to a partner of their own age. This is the most common way that hiv passes from one age cohort to the next. Breaking that link would allow the younger cohort, who are largely virus-free before they become sexually active, to stay that way. “If you can reduce [new infections among] young girls, you break the back of the pandemic in Africa,” says Dr Salim Abdool Karim, an epidemiologist (who is married to Quarraisha Abdool Karim). A tangle of social problems makes everything harder. Poverty is one. If you are poor, getting tested can be a challenge even if the test is free. A day off work and a bus fare to the clinic can scupper your budget. Male violence is another obstacle. A study in six African countries found that women who had been physically abused in the previous year were 3.2 times more likely to have been infected with hiv recently. Women who live in fear may find it harder to say no to unprotected sex. And the first wave of aids, by killing so many parents, made families in some countries even poorer and more unstable than they already were. In South Africa, for example, thanks to a long tradition of migrant labour under apartheid and the recent ravages of aids, only a third of children live with both biological parents. Social dysfunction helps the virus spread. Thulina Moukangwe was raped by four different relatives, starting when she was 11. She does not know which one infected her. She did not get tested until she was 17, “because I was young and ignorant”, she says. She received little support from her chaotic family, and did not seek treatment for another five years. Fear of death can make bad boyfriends behave even worse. After Makhosazana Molotsane tested positive her partner was furious. For years he refused to get tested himself, drunkenly sang in the street that she was bringing disease into his home, and burned the condoms Ms Molotsane wanted to use. He seized her antiretroviral drugs and tossed them away. She hid her pills in a nappy bag. He beat her up; eventually she left him. Both women’s fortunes eventually improved. Ms Molotsane, who is 40, found a more supportive partner, who reminds her to take her drugs. Her viral load is low enough that her doctor tells her it is safe for them to have a baby. Ms Moukangwe, who is now 29, has become a “peer educator”: a volunteer who helps people make informed decisions about their health. This is one area where ngos are especially useful. Health services are overstretched, and people often resist instructions from officials. A more effective way to persuade scared, reluctant people to take the right medicine is for them to talk to people from similar backgrounds. Ms Moukangwe, who had heard that antiretroviral drugs “made you crazy”, started taking them after she saw that a friendly volunteer, who had been taking them for years, was sane and healthy. “You can’t just tell people to go to a clinic,” says Ms Moukangwe. “I talk about myself, as a way of encouraging others.” Private companies pitch in, too. Mining firms in southern Africa saw aids as a huge threat two decades ago. Their workers were often migrants, who lived far from their families in hostels surrounded by prostitutes. Companies such as Anglo American started offering staff free testing and antiretroviral drugs even as South Africa’s president at the time, Thabo Mbeki, publicly questioned their efficacy. It was a delicate task, recalls Brian Brink, who used to run Anglo’s aids programme. Unions had to be convinced that tests would not be used to identify sick staff and fire them. Stigma lingers even in countries where nearly everyone knows someone with hiv. People worry that if they get tested near home, or pick up antiretrovirals from a pharmacy, a neighbour will spot them, says Mr Mdletshe. This makes it less likely that they will get tested in the first place, or stick to a lifelong drug regimen. Sometimes stigma is compounded by law. Some 168 governments criminalise aspects of sex work. This deters sex workers from seeking help. Nokwanda Gambushe, an activist in Durban, complains that cops search sex workers’ handbags and, if they find condoms, arrest them. This hardly encourages safe sex. In addition, 145 countries criminalise drug use and 67 criminalise gay sex. The sharp increase in infections in Eastern Europe and the Middle East is largely due to a lack of prevention services for marginalised populations, reckons unaids. Uganda introduced the death penalty this year for “aggravated homosexuality”, which might make gay Ugandans think twice before walking into a clinic to get tested. Policy can make a huge difference. President Mbeki’s aids denialism cost an estimated 300,000 South African lives. However, when he was sacked by his party in 2008, experts persuaded a caretaker government to adopt a first-rate aids policy. Drugs were swiftly rolled out, and between 2009 and 2012 the proportion of children under five in South Africa who were orphans plunged from 12% to 7.3%. The best foundation for fighting aids is a well-functioning public health system with short queues and sensitive staff, says Mr Mdletshe. Many countries fall short. Waiting times are often long, pharmacies run out of pills, staff are sometimes judgmental. When Ms Moukangwe tested positive, a nurse shouted at her for her lax morals. Even in rich countries, governments that fail to prioritise the disease tend to deal with it badly. The proportion of infected people taking antiretroviral drugs is actually lower in Eastern Europe and central Asia than in sub-Saharan Africa. Governments do not work in a vacuum. The places that have come closest to hitting the 95-95-95 targets are typically African countries where donors are pouring in resources and expertise, such as Botswana, Rwanda, Tanzania and Zimbabwe. The second tier are often rich countries with generous public services (Denmark, Saudi Arabia) or places that developed a serious anti-aids strategy early on in the pandemic, such as Cambodia and Thailand. One of the biggest obstacles to curbing the spread of hiv is that the symptoms take a long time to appear. “Recently infected people have high viral loads, and are more likely to infect others. The problem is that those who have been infected don’t yet know it,” laments Dr Salim Abdool Karim. “The gap between being infected and being tested is usually years.” So he suggests something radical: offering prep to girls in schools. Instead of waiting for those who think they are at risk to come to a clinic, health workers should go to schools and offer prep to all the girls above a certain age, along with testing, contraception and other healthcare services. This could meet stiff resistance from traditionalists who think it would encourage promiscuity. Also, “[it] is only feasible if you have a prep that lasts six months,” says Dr Salim Abdool Karim. “You can’t keep going to the schools more than…once every six months. It’s not practical.” Longer-lasting drugs are in the pipeline, and could “change the trajectory” of the disease, says Deborah Waterhouse, the boss of Viiv. The first not-for-profit delivery of Viiv’s two-month injection, to pepfar, will be in October. It has regulatory approval in four southern African countries, and has been licensed to cheap generic manufacturers. Gilead, an American firm, has a drug called lenacapavir, which is already used as a treatment, and which breaks down so slowly that it might work as a prophylaxis for six months. It is in clinical trials among girls in South Africa and Uganda. Rolling out new drugs would cost a lot. Roughly $21bn was spent on fighting hiv in poor and middle-income countries in 2022, with slightly less than half coming from donors; unaids thinks $29bn will be needed in 2025. To those who would penny-pinch, Mr Sands retorts that it is “rational to hit this thing hard and fast”. Fighting aids slowly would be “much more expensive…If you don’t reduce the number of new infections, every new infection is translating into a lifetime of antiretroviral treatments...and complications.” A lifetime of treating someone with hiv in a poor country costs around $5,000, by one estimate; in rich countries, it is $380,000. By comparison, the cost of averting an infection in Zambia or South Africa is $2,000-$3,000, according to a different study published in the Lancet in 2021. And so long as the virus is circulating somewhere, nowhere is safe.  © 2023 The Economist Newspaper Limited. All rights reserved.