Microlending gives hope to the HIV positive

A microcredit program created by Thailand's 'Mr. Condom' allows the HIV positive to start businesses and earn a living.

By Robert Horn, Fortune
May 21 2007: 6:03 AM EDT
(Fortune Magazine) -- When Narisara Panya's husband died of AIDS seven years ago after returning to Thailand from a construction job abroad, it was devastating. With only a small plot of land that didn't always yield enough food for their two children, 44-year-old Narisara - who became HIV positive herself - needed an income. But because she was stigmatized in her community, even after starting antiretroviral therapy, no one would hire her. And no banks, or even loan sharks, would lend her money to start a business. "They were afraid of the illness and thought I would die before being able to pay them back," she says.

An experiment in microcredit came to her rescue. With a 24,000 baht ($685) loan from a program called Positive Partnership, Narisara was able to set up a small business selling ginseng tonic and herbal supplements in roughly 100 neighboring villages. Now she and her business partner earn 8,000 baht ($228) a month each, more than twice the average income in their village in northeastern Thailand. "My customers know I'm HIV positive," Narisara says, but they don't care. "They are surprised at how healthy I look."



Banking on third-world small businesses
Microcredit is hardly new. Several programs, including ones for the HIV positive, have been modeled after Bangladesh's Grameen Bank, founded by Nobel laureate Muhammad Yunus. The innovation here is partnership: To get a loan, a person with HIV must find an uninfected partner. Instead of being a burden, people with HIV now bring money into the community.
Narisara found a neighbor, Pojana Soengern, whose niece had died of AIDS. "People see from our example that someone like me who does not have HIV can work with someone like Narisara who does, and I am perfectly safe," Pojana, 55, says. "This project has improved my life too."

The program is the work of Thailand's famous AIDS campaigner, Mechai Viravaidya. He earned the nickname "Mr. Condom" when, as a cabinet minister in the 1990s, he was largely responsible for Thailand's HIV-prevention program that the World Bank credits with sparing 7.7 million Thais. In recent years, Mechai says, government efforts have slackened. So in 2004, as head of the nonprofit Population Development Association, he reached out to the private sector. U.S. pharmaceutical giant Pfizer (Charts, Fortune 500) has donated $300,000 and employee expertise; it recently pledged $100,000 more. Other funders include Bangkok Bank and Novartis (Charts). "This isn't charity," Mechai says. "The program works because it uses a business approach."

Ironically, the program is gaining recognition just as a battle has erupted between Thailand and Big Pharma over the country's decision to produce generic versions of HIV drugs made by Abbott Laboratories (Charts, Fortune 500). Abbott accuses Thailand of violating its patent and refuses to introduce new medicines there. Thailand claims its actions are legal under a World Trade Organization agreement.
Pfizer, watching from the sidelines, makes few HIV drugs and doesn't market them in Thailand. Its new HIV drug approved in the U.S. in April won't be available in Thailand until 2011 because of a lengthy approval process. By then, Pfizer expects Thailand and Big Pharma will have ironed out their differences.
Meantime, the payoff for Pfizer is goodwill. "Our philosophy is to take a more holistic approach to public health," says Pfizer spokesman Anutra Sinchaipanich. "Improving the lives of people with HIV is part of that."
Breaking down the stigma of HIV has advantages for the industry. Fear of discrimination keeps people from getting tested, so they stay out of the health-care system or seek care too late. Pariah status can cause depression and nonadherence to drug regimens. Resistance builds, creating the need to develop new drugs faster.

From microcredit to microcapitalism
Although Africa remains the continent most severely affected, according to the United Nations, HIV is spreading faster in Asia, primarily China, Indonesia and Vietnam, with one million new infections every year. An effective response would cost just 4 percent of most national health budgets, says Swarup Sarkar, a UN epidemiologist. HIV is most devastating to those on the borderline of poverty. More than five million people are impoverished each year in Thailand, Cambodia, India and Vietnam alone, according to the Asian Development Bank. "HIV pushes people into destitution," Sarkar says.


Positive Partnership pulls them out, having funded more than 600 businesses so far: Kanchana Tunpu, who is almost blind, started cattle breeding in partnership with a cousin; in a nearby village, Supinya Lekyumadan turned to a lifelong friend as a business partner to buy tools and equipment to expand her stone-carving business.
With a repayment rate of 91 percent, the program is drawing attention. The U.S. Agency for International Development and the Population Council have recommended scaling up the project. The UN Development Program recently shepherded fact-finding delegations from China, India, and Cambodia with the goal of starting similar ones.
"Before we had the project, people were just afraid," says Narisara, who appears well and is healthy. Without Positive Partnership, "I would be dead. But now I want to live. Now I can stand on my own feet."

From the May 28, 2007 issue

SPAIN: Power station harnesses Sun's rays

By David Shukman
Science correspondent, BBC News, Seville

There is a scene in one of the Austin Powers films where Dr Evil unleashes a giant "tractor beam" of energy at Earth in order to extract a massive payment.
Well, the memory of it kept me chuckling as I toured the extraordinary scene of the new solar thermal power plant outside Seville in southern Spain. From a distance, as we rounded a bend and first caught sight of it, I couldn't believe the strange structure ahead of me was actually real. A concrete tower - 40 storeys high - stood bathed in intense white light, a totally bizarre image in the depths of the Andalusian countryside. The tower looked like it was being hosed with giant sprays of water or was somehow being squirted with jets of pale gas. I had trouble working it out.
In fact, as we found out when we got closer, the rays of sunlight reflected by a field of 600 huge mirrors are so intense they illuminate the water vapour and dust hanging in the air. The effect is to give the whole place a glow - even an aura - and if you're concerned about climate change that may well be deserved. It is Europe's first commercially operating power station using the Sun's energy this way and at the moment its operator, Solucar, proudly claims that it generates 11 Megawatts (MW) of electricity without emitting a single puff of greenhouse gas. This current figure is enough to power up to 6,000 homes. But ultimately, the entire plant should generate as much power as is used by the 600,000 people of Seville.
It works by focusing the reflected rays on one location, turning water into steam and then blasting it into turbines to generate power. As I climbed out of the car, I could hardly open my eyes - the scene was far too bright. Gradually, though, shielded by sunglasses, I made out the rows of mirrors (each 120 sq m in size) and the focus of their reflected beams - a collection of water pipes at the top of the tower. It was probably the heat that did it, but I found myself making the long journey up to the very top - to the heart of the solar inferno. A lift took me most of the way but cameraman Duncan Stone and I had to climb the last four storeys by ladder. We could soon feel the heat, despite thick insulation around the boiler. It was like being in a sauna and for the last stages the metal rungs of the ladders were scalding.
But our reward was the cool breeze at the top of the tower - and the staggering sight of a blaze of light heading our way from down below. So far, only one field of mirrors is working. But to one side I could see the bulldozers at work clearing a second, larger field - thousands more mirrors will be installed.
Letting off steam
I met one of the gurus of solar thermal power, Michael Geyer, an international director of the energy giant Abengoa, which owns the plant. He is ready with answers to all the tricky questions. What happens when the Sun goes down? Enough heat can be stored in the form of steam to allow generation after dark - only for an hour now but maybe longer in future. Anyway, the solar power is most needed in the heat of summer when air conditioners are working flat out.
Is it true that this power is three times more expensive than power from conventional sources? Yes, but prices will fall, as they have with wind power, as the technologies develop. Also, a more realistic comparison is with the cost of generating power from coal or gas only at times of peak demand - then this solar system seems more attractive. The vision is of the sun-blessed lands of the Mediterranean - even the Sahara desert - being carpeted with systems like this with the power cabled to the drizzlier lands of northern Europe. A dazzling idea in a dazzling location.
HOW THE SOLAR TOWER WORKS
1. The solar tower is 115m (377ft) tall and surrounded by 600 steel reflectors (heliostats). They track the sun and direct its rays to a heat exchanger (receiver) at the top of the tower
2. The receiver converts concentrated solar energy from the heliostats into steam
3. Steam is stored in tanks and used to drive turbines that, eventually, will produce enough electricity for up to 6,000 homes

India pledges to abolish poverty

By Steve Schifferes
Economics reporter, BBC News

India's finance minister, Palaniappan Chidambaram, has pledged to end poverty in India within two generations.
Mr Chidambaram told BBC World Service that if economic growth continued, India could end poverty by 2040. India would play its part in the post-Kyoto negotiations on climate change, he said, though he insisted that "we have a right to grow". Mr Chidambaram also vowed to protect poor farmers from the ravages of free trade in agriculture.
Poverty and growth
Mr Chidambaram, who became finance minister in 2004 after the Congress Party unexpectedly won the general election, has presided over an Indian economy which is currently growing at 9% per year, almost as fast as China.
He told the BBC that his task was "to ensure not only growth but that this growth is inclusive growth" which reaches India's 250m poor people. Mr Chidambaram said that "growth is the best antidote to poverty". "Growth gives incomes to people with jobs, throws up jobs for those who are not employed," he said. "Therefore growth is imperative, but it is not sufficient in a country ... where a significant number live in poverty."
The finance minister said it would take until 2040 to wipe out "abject poverty" but he was confident that if growth continued to be strong, it would happen. "We will not have the abject poverty that afflicts about 25% of India's population. People will have homes, work, food, clothing, and access to education and medical care."
Climate change
With negotiations entering a delicate phase on climate change, the position of India and China - who were not given any pollution targets in the Kyoto round of talks - is being closely watched.
Mr Chidambaram said that the West was being unfair to India by demanding sharp cuts in emissions just as India's economy was taking off. "When the developed world was growing, no one asked them: why are you consuming so much energy, why didn't you slow down?" he said. "The point is, we have the right to grow, just as much as the US and Europe had a right to grow in the 19th and 20th centuries." But he said that India was willing "to take our share of responsibility, provided we have access to clean technologies and clean development mechanisms."
Trade
The finance minister said that India's openness to the forces of globalisation had helped stimulate growth, but that there were winners and losers. "The positive aspects of globalisation will be greater capital flows, more trade, more jobs in the services sector, more exports," he said.
India's IT services sector has become a global leader in outsourcing, and earns $25bn a year which boosts India's foreign exchange reserves. The finance minister said it was a myth that India's advantage was its cheap labour. "The point is, India's labour is skilled, and today we are a major hub of manufacturing," he said. "We even export Mercedes Benz cars made in India back to Germany."
But Mr Chidambaram accepted that there were also potential losers, especially in the agricultural sector, which still employs the majority of the workforce. "The negative aspects which we are guarding against are the impact on agriculture," he said. "Agriculture in India today is a livelihood issue, which is why, when we go to the WTO, we do not look at agriculture simply as a trading issue, we have to protect the livelihood of millions of people," he added.
And the finance minister said India would stand firm. "If the developed countries continue to subsidise agriculture and then seek access to India's market, it will of course immiserise our farming population, and we will never let that happen." His remarks on this score will not be seen as helpful for the resumption of world trade talks, which have been stalled since the summer over the issue of agricultural subsidies.
Infrastructure woes
Some economists worry that India will not be able to sustain its high rate of economic growth unless it can dramatically improve its ageing infrastructure. But Mr Chidambaram said that foreign investment could help overcome the infrastructure gap, provided that India "continues to observe fiscal prudence... ensures that there is an enabling environment for investors, both foreign and domestic... and ensure that these investments are made widely and managed wisely."
And the markets seem to agree with him. India's international credit rating was recently upgraded by credit agencies, and foreign investment has been surging into the country - although India is still a long way behind China on that score.
Mr Chidambaram was interviewed by Mike Williams for "The Interview", broadcast on BBC World Service on 3/4 February.

In Loving Memory of Lester Harold Young, 1921-2004

Male Breast Cancer
Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2005, when 211,400 women were diagnosed with breast cancer in the United States, 1,690 men were diagnosed with the disease.

You may be thinking: Men don't have breasts, so how can they get breast cancer? The truth is that boys and girls, men and women all have breast tissue. The various hormones in girls and women's bodies stimulate the breast tissue to grow into full breasts. Boys' and men's bodies normally don't make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Still, you may have seen boys and men with medium-sized or big breasts. Usually these breasts are just mounds of fat. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.

Because breast cancer in men is rare, few cases are available to study. Most studies of men with breast cancer are very small. But when a number of these small studies are grouped together, we can learn more from them.

I miss my Dad every moment of every day.

The Dinka of Southern Sudan

Dusty sums

Now that 21 years of war in South Sudan is over, the government is starting to provide social services, such as education.
This school, the first of its kind in its region, is a private school and now has more than 100 pupils. But getting basic supplies in a region with very few roads is a huge challenge.

The children practise their maths in the dirt because they do not yet have access to paper and pencils.



Traditional banks

For countless generations, cattle have played a central role in the life of many African peoples, such as the Dinka of South Sudan, Micah Albert writes.
In the absence of banks, cattle are used as a store of wealth.

Some Dinkas will be rich in cattle terms - with hundreds of animals - and yet they will go hungry and wear rags.

Cattle camps are where Dinka culture is passed down to the next generation.