Harm Reduction Project - News, Information, & Opinion: July 30, 2007

News & Opinion This Week 1. How, and How Not, to Stop AIDS in Africa 2. Transcending God B Upcoming Conference C Quotes D How To Help E About HRP F Subscription Information -------------------------------------------------------------------------------- I. How, and How Not, to Stop AIDS in Africa By William Easterly The Invisible Cure: Africa, the West, and the Fight Against AIDS by Helen Epstein Farrar, Straus and Giroux, 326 pp., $26.00 From Volume 54, Number 13 August 16, 2007 of The New York Review Of Books One of the classic works of journalism of the last couple of decades was Randy Shilts's And the Band Played On[1] about the sluggish response to AIDS in the 1980s in the United States, which indicted both the Reagan administration and the leaders of the gay community. I still remember the sense of outrage I felt when reading Shilts's book; it struck just the right note, leaving one both horrified about the tragic incompetence of so many and yet also hopeful that someone, somewhere could do things better next time. Yet after reading Helen Epstein's masterful new book, the response to AIDS in America now looks in retrospect like a model of courage, speed, and efficiency by comparison with the response in Africa. In the US, the government publicized the threat and funded research, the gay community reduced its infection rates by encouraging less risky sexual behavior, the dreaded breakout into the heterosexual population never happened, and AIDS receded to become a disease that, while still tragic, could in most cases be kept under control with expensive new antiretroviral drugs (ARVs). The opposite is true in every respect of AIDS in Africa, which was anticipated as a looming crisis already in the 1980s, yet governments, foreign aid agencies, and even activists reacted with denials and evasion. The disease rampaged through the heterosexual population and is still rampaging, ARVs were too late, too costly, and available to too few, and Africa is still in the midst of an epic disaster without a solution in sight. As of the latest figures in 2006, 25 million Africans are HIV-positive, 2.1 million die from AIDS every year, and 2.8 million are newly infected each year.[2] Epstein's book lays all this out in courageous and thought-provoking detail, describing the maddening complexity of the AIDS crisis in Africa, and the reprehensible and simplistic evasions of nearly everyone involved. It is not only a book that should be required reading for people concerned in the least with AIDS or with Africa; it is also compulsively readable. It is not without some flaws. Epstein's discussion of the economics of African poverty is overly simple-it sometimes sounds more like flat statements about corporate and official power than deep analysis. More seriously, for some of her key points, the evidence base-the numbers of studies and of people and the different groups whose experience she draws on-seems a little thin, although I found her points plausible and largely convincing. Perhaps the fact that there is insufficient evidence about so many aspects of AIDS in Africa is itself a symptom of the skewed priorities that the book describes as afflicting the international AIDS effort. The history of the response to African AIDS can be divided into two phases: (1) fiddling while Rome burns, and then (2) trying to use the fiddles to put out the fire. Phase I began long ago, undermining any claims of any of those involved to ignorance of the problem. An article published in the London Times on October 27, 1986, said: A catastrophic epidemic of AIDS is sweeping across Africa.... The disease has already infected several millions of Africans, posing colossal health problems to more than 20 countries.... "Aids has become a major health threat to all Africans and prevention and control of infection...must become an immediate public health priority for all African countries," says a report published in a leading American scientific journal. Signs of the coming epidemic had appeared even earlier. A sample of prostitutes in Butare, Rwanda, in 1983 found that 75 percent were infected with HIV. A later study reporting this statistic dated the general awareness that Central Africa was at risk for the spread of AIDS back to 1983 as well.[3] An article in 1991 in the World Bank/ International Monetary Fund quarterly magazine predicted that 30 million people would be infected worldwide by the year 2000 if nothing were done.[4] This was not far off the actual outcome in 2000, so sixteen years ago many knew that a catastrophic epidemic was underway. One of the lead organizations for fighting the African epidemic was the World Bank, which says today on its AIDS Web site that it is "the largest long-term investor in prevention and mitigation of HIV/AIDS in developing countries." In its first AIDS strategy report in 1988, the World Bank said the crisis was urgent. It presciently detected "an environment highly conducive to the spread of HIV" in many African countries. It noted that the epidemic was far from reaching its full potential and that "the AIDS epidemic in Africa is an emergency situation and appropriate action must be undertaken now."[5] Yet the World Bank's effort at the time was pitiful: it made a grant of $1 million to the World Health Organization (WHO) in the 1988-1989 fiscal year to fight AIDS. The World Bank sponsored only one project dedicated to AIDS before 1993 (an $8 million loan to President Mobutu of Zaire in 1988). Over the entire period between 1988 and 1999, it spent $15 million a year on all AIDS projects in Africa. In 1992, another World Bank report noted that it "has done little to initiate prevention in countries in which the risk of spread is high." Yet the 1992 report closed with the inexplicable admonition that "AIDS should not be allowed to dominate the Bank's agenda on population, health, and nutrition issues in Africa." Other aid organizations did little better. What explains such fateful inaction? There was a failure of courage on the part of both Western aid agencies and African leaders, and misinformation that made both parties reluctant to press the issue. As Epstein explains, Western scientists had identified the continent as the source of the worldwide epidemic, and pinpointed a virus in monkeys that had somehow jumped to humans as having initiated it. There were still plenty of mysteries: How had the jump happened? When did it happen and why? Why did the virus not spread before the 1980s and then why did it spread so rapidly in Africa afterward? Epstein discusses what is known and unknown about these questions, which makes fascinating reading. Perhaps what is even more relevant than the right answers to the questions, however, is the way that the wrong answers inhibited the response to the epidemic. Western scientists flew into Africa, collected blood samples, and flew out, seemingly much more interested in getting recognition in the Western press than in communicating useful and sensitive knowledge to African leaders and the public. Scientists carelessly put forward hypotheses about African promiscuity without considering how important it was to avoid any unnecessary stigma that would provide an excuse for denial by African leaders. The press and television portrayed (and still does portray) Africans as being almost universally HIV-positive. Would African AIDS become less of a tragedy if the press reported accurately that HIV-positive individuals make up just 3 percent of the population of sub-Saharan Africa? Of course, being accused of promiscuity and having Africans labeled as the equivalents of Typhoid Mary did not make their leaders or the general population all that receptive to messages from Western scientists on how to confront the epidemic. Many Africans reacted with a mixture of denial and conspiracy theories. Maybe the CIA had targeted Africans during the cold war with a scientifically engineered virus, perhaps spread through vaccination campaigns. In South Africa, there was a claim that the apartheid government had targeted black South Africans for decimation through the HIV virus (a conspiracy theory that may not have seemed so far-fetched in view of the evil deeds of the South African secret service under apartheid). As Epstein chronicles, South African President Thabo Mbeki and Health Minister Dr. M.E. Tshabalala-Msimang also consorted with AIDS quacks who doubted that HIV caused AIDS. Few in Africa or the aid agencies lending to Africa wanted to talk about AIDS with these ideas in the air. A more mainstream but also damaging view of the Western AIDS experts was that the spread of AIDS in Africa was driven by "core transmitters," such as prostitutes and the truck drivers and migrant workers who patronized them. This was a theory favored by the World Health Organization and World Bank, as set out in the bank's 1997 AIDS report. This new theory added yet more layers of stigma and denial. If AIDS victims were prostitutes or patrons of prostitutes, who was going to admit being HIV-positive? Or that their late relatives died of AIDS? This could explain some of the astonishing wall of silence surrounding AIDS that Epstein documents and that still prevails among both the African public and politicians. Of course, such theories may well have been true-maybe AIDS was the result of the sex trade and promiscuity. So some Westerners advised Africans: just try to overcome the stigma as best you can. Treat the problem at its source by getting prostitutes to force condoms on their customers. The rest of the population could breathe easy as long as they did not use prostitutes or sleep promiscuously with men who did. Epstein's contribution is to say loudly that this conventional wisdom is wrong. The stigma attached to the HIV-positive, and the implied general stigma for Africa, were tragically misguided. According to survey evidence Epstein provides, Africans are no more promiscuous than most other people, as measured by numbers of sexual partners in a lifetime, casual sexual encounters, and visits to prostitutes. As she says, sexual behavior in Africa is governed by strict rules; they are just different rules from those prevailing elsewhere. She argues that in many African countries the large numbers of people willing to follow those rules have a great deal to fear from AIDS; and they must know they cannot dismiss the problem of infection as one of a whoring minority. The international aid agencies and Western governments are only now belatedly coming around to Epstein's perspective (which is based on the findings of a number of independent researchers), over two decades after the start of the epidemic, and they still don't know quite how to handle it. Epstein's view is that the cause of the AIDS crisis in Africa is what has now become known in AIDS jargon as "concurrent" relationships. Africans have about the same number of sexual partners as anyone else; they are just more likely to have more than one long-term partner at a time. Crucially, both men and women have multiple partners, in contrast to other poor societies where men may often stray but women's monogamy is jealously guarded. Western men and women are more likely to practice serial monogamy or engage in one-night stands. To oversimplify a little, Africa's AIDS tragedy is that it combines greater Western-style sexual equality for women with social norms that permit simultaneous long-term sexual relationships for both partners. Multiple long-term relationships are prevalent in Africa for many reasons. In southern Africa (where the epidemic is concentrated), one of the few opportunities for gainful work open to men is to become long-distance migrants to the mines. Both husbands and wives may have other long-term partners during the months when they are separated. The African tradition of polygamy (described by historians like John Iliffe as a cultural response to maximize fertility in what used to be a lightly settled continent) has given way to modern relationships between older, well-to-do, gift-bestowing men and multiple young girlfriends. This is not so different from the successive trophy wives of American fat cats, but much more widespread since Africa's poverty often makes it a matter of survival for African young women to have a rich (older) boyfriend. The desire of young women for young boyfriends can be accommodated on the side. For many reasons, concurrent, long-term sexual relationships are much more dangerous for the spread of AIDS than serial monogamy. When both men and women have concurrent relationships, they are part of a huge web of sexual partners by which the HIV virus moves through the population. Long-term relationships are much more likely to spread AIDS than one-night stands because of the low probability of a single sex act spreading the virus. Since the HIV-positive are most contagious soon after they themselves become infected, a long-term partner who has just become infected in another relationship poses much more risk than a prostitute who has been infected for a long time. Serial monogamy in the West kept the virus largely trapped within single relationships, a fact Epstein nicely illustrates with some clever graphs. Her explanation based on concurrent relationships has gained broad acceptance and has been confirmed by mathematical modeling and by surveys of sexual habits in various countries; but one still wishes the evidence was a little more extensive for such a critical issue. At this point, however, it looks like much stigma, denial, and inaction took place simply because of lack of understanding of African sexual behavior. We have since emerged from the Age of Inaction to the Age of Ineffective Action. In Africa, AIDS is now a multibillion-dollar industry, with the US President's Emergency Plan For AIDS Relief (PEPFAR), the Global Fund for AIDS, Tuberculosis, and Malaria (GFATM), the United Nations' AIDS consortium, UNAIDS, and major efforts by the World Bank, the World Health Organization, the Gates Foundation, and national aid agencies. Unfortunately, these well-meaning efforts are badly weakened by political agendas, misdirected priorities, ignorance, and plain incompetence. To illustrate the role of political agendas, Epstein discusses the famous success story by which AIDS infection rates in Uganda decreased as a result of the ABC campaign-"Abstain, Be Faithful, and Use Condoms." Epstein damns both the Western right and left for their misuse of the lessons of Uganda. The religious right played up the "Abstain" part because it happened to fit their particular moral preferences. People on the left, who had different sexual morals, said just use condoms. The "Be Faithful" message, precisely the one in Epstein's story that was critical in Uganda (led by Ugandan President Yoweri Museveni, who called for "Zero Grazing"), was a political orphan, disdained by both left and right. The response of the aid industry to AIDS has its own ABC, much less effective than its Ugandan counterpart: antiretroviral drugs, bureaucracy, and consultants. A huge part of the Western response has been concentrated on getting antiretrovirals to those in Africa with full-blown AIDS. There is nothing wrong with the urge to treat the sick, but in practice it has crowded out nearly every other response to the epidemic. ARVs are now reaching only a tiny minority of those in need and it will never be feasible to treat everyone. Even if you avoid the Scylla of insufficient money to pay for the expensive treatments, you run into the Charybdis of Africa's dysfunctional health care systems. And even if you did treat everyone who has AIDS with ARVs, which add a few years-four or five, Epstein notes, according to current UN estimates-to the lives of people who remain terminally ill, that would still ignore the omnipotent question: How do you stop AIDS from spreading further through this generation and into the next generation?[6] Alas, the glory that people get from sponsoring AIDS treatment so blinds the politicians and celebrities involved in AIDS causes that they can't keep elementary medical math straight. So not only did the most relevant part of prevention strategies-"Be Faithful"-lack political sponsorship. But prevention itself has been badly neglected in favor of the privileged method of treatment. For example, take the World Health Organization/UNAIDS April 2007 publication, Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector. Somehow prevention did not make the cut as an intervention deserving priority in this document, which is all about treatment. (There is one mention of "counseling" that hints prevention may have briefly crossed the minds of the authors.) To promise "universal access" to treatment-a promise that cannot be kept and that nobody is held accountable for keeping anyway-while saying nothing about the prevention that would stop the epidemic itself is so irresponsible that even a hardened student of UN evasions is left gasping. The UN's lack of accountability perhaps explains such flagrant irresponsibility. President Bush's PEPFAR doesn't fare much better in Epstein's account. In fiscal year 2006, by design, less than a quarter of PEPFAR's budget was spent on prevention, and a hefty chunk of that went for the useless abstinence campaigns. In a revealing incident earlier this year, the American ambassador to South Africa sent a letter to PEPFAR contractors telling them to cut back on prevention-but not treatment-activities for the next year because of a budget squeeze. He said: "Our priority must be delivery of treatment services."[7] The neglect of prevention is bipartisan. Former President Bill Clinton has been admirably active in fighting AIDS in Africa. The issue that occupies him is of course treatment (specifically, negotiating cuts in drug prices). In his speech to the International Aids Conference in 2006, he went into great detail about what the Clinton Foundation had accomplished in making treatment available; but he talked of prevention only in a kind of ritual incantation with no details, except to mention quick technical fixes like microbicides and AIDS vaccines-which at this point don't exist-or the magic bullet of HIV testing, although there is little evidence that it is effective in preventing the disease. When well-conceived efforts to improve prevention do exist, they often run afoul of the aid industry. Epstein observes that there was already a huge international bureaucracy devoted to combating population growth by distributing condoms. When suddenly condoms became marketable for preventing AIDS as well as pregnancy, this presented a huge new growth opportunity for family-planning organizations (which had been losing foreign aid market share as people realized that population growth was not as scary as originally thought). The condom bureaucracy did what it does best, which is flood countries with condoms. Alas, supply does not create its own demand. Condom-saturated countries like Botswana have made little progress in reducing new AIDS infections, since people there don't like to use condoms and are not yet convinced that they are at risk of HIV infection if they don't. Meanwhile, the "Be Faithful" message was neglected because it was not of interest to the bureaucracy concerned with AIDS. As Epstein muses acidly: "Zero Grazing" had "no multimillion-dollar bureaucracy to support it." Then there is the bureaucracy's bean-counting approach to problem-solving. Epstein describes how the measurement of "results," such as the number of people counseled to practice safe sex, defeated its own purposes. The "results," as is common in foreign aid, were really inputs rather than outputs-what was being measured was the numbers of people counseled, not the behaviors actually changed by counseling. Moreover, the emphasis on quantities had the predictable effect of diminishing the quality of the aid being given. As one frustrated counselor quoted by Epstein said: If you have to do one thousand people by the end of the month, you end up not doing good counseling.... They're not asking "are we really meeting the needs of these people." Alas, even these efforts look like models of bureaucratic efficiency compared to some of the other activities of the UN agencies and the World Bank. Plans, strategies, and frameworks are favored activities in foreign aid-this is what aid bureaucracy does. Then the bureaucracies "coordinate" their respective strategies with the others. One bureaucracy's output serves as another bureaucracy's input, with the output of the second bureaucracy then feeding back as an input into the first bureaucracy's output. For example, the World Bank announces that its plan to fight AIDS is to produce more plans. It advocates strengthening national HIV/AIDS strategies, to ensure they are truly prioritized and strategic, integrated into development planning.... The World Bank will focus intensively on improving national HIV/AIDS strategies and annual action plans. ... Support for a network of country practitioners will be provided to help countries to develop strategic, prioritized national plans.... Enhanced Country Assistance Strategy (CAS) and Poverty Reduction Strategy (PRSP) guidelines and assessment criteria will aim to support better integration of HIV/ AIDS into national development planning and better aligned national AIDS responses.... The Bank will continue to provide financial and technical support...to enhance country capacity and systems to implement national HIV/AIDS plans...[and] work with countries and Bank project teams to further improve planning.[8] This repetitive exposition on how strategies should be strategic is to be found in the short version, or executive summary, of a seventy-eight-page report. Those who can, act; those who can't, produce plans. The World Bank will do all this through "partnerships across Bank units, working closely with client countries, UNAIDS co-sponsors, GFATM and other development partners." As for UNAIDS, it is "monitoring the progress on the UNGASS [the apt acronym for the UN General Assembly] Declaration of Commitment on HIV/AIDS." It was one of these progress reports that ignored the need for prevention. UNAIDS issues such documents when it is not busy engaging "diverse partners and stakeholders, including inter-governmental bodies, governments, other key partners, UNAIDS and the broader UN system." This Kafkaesque maze of the AIDS bureaucracy would be comic, except for the millions of nonbureaucrats who are dying of AIDS. The C in the aid industry's ABC is for the consultants from the West who implement AIDS programs, often slighting homegrown efforts. Epstein gives an example of how a decent homegrown organization that cares for AIDS orphans, called Sizanani, was starved of funds in South Africa. Meanwhile, high-powered, foreign-sponsored organizations like one called Hope Worldwide (founded by American fundamentalists) skillfully captured PEPFAR dollars. Hope Worldwide offered Sizanani a "memorandum of understanding" in which it would provide advice but no money. Apparently it wanted to count Sizanani's orphans toward its target of "orphans helped" in order to meet PEPFAR's demand for results. Elizabeth Rapuleng, an elderly African woman who founded Sizanani, said, "When the Americans come, we sing, we dance, they take our picture, and they go back and show everyone how they helping the poor black people. But then all they do is hijack our projects and count our children." Other firms engage in Madison Avenue marketing campaigns to spread sexy messages about safe sex. Epstein dissects one such Western-funded campaign called loveLife, whose leader describes it as "a brand of positive lifestyle." Throughout South Africa, the campaign has built recreation centers (loveLife Y-Centers) for young people, where they can hear American motivational speakers tell them to believe in themselves, all of which has shown no sign of working to halt the spread of AIDS. Why would it? As Epstein describes a bitter saying in Uganda, there is Slim AIDS and Fat AIDS. Slim AIDS is what happens to the emaciated victims of HIV. Fat AIDS is what happens to the consulting companies who win contracts from International AIDS Inc. Epstein argues that it violates both common sense and the evidence to put much faith in vague, happy-sounding messages about self-esteem and safe sex. During visits to Africa I have often seen the ubiquitous donor-funded "AIDS prevention" billboards, featuring beautiful young couples who are meant to convey-well, what exactly? Epstein (backed up by an epidemiological study of the Uganda prevention success story) argues that the prevention campaigns could use less sexiness and more fearfulness. What worked in Uganda, she writes, was the "ordinary, but frank, conversations people had with their family, friends, and neighbors-not about sex-but about the frightening, calamitous effects of AIDS itself." This is Epstein's "Invisible Cure." Ugandans had enough social cohesion in their densely settled agricultural country so that the discussions about the calamity of AIDS and the urgent need to change behavior could well up from the bottom of society, rather than resulting from any bureaucratic action plan or consultants' marketing campaign. What was crucial was open and active recognition of the danger, and community encouragement of families to avoid risk. By contrast, in the more dislocated and anonymous environments of southern African cities and mining camps, denial of the AIDS problem behind a wall of silence was the dominant attitude (undeterred by the efforts of Western AIDS bureaucrats, who didn't even understand the problem). One still wishes that the evidence for what works was a little more substantial than one Ugandan success story that lasted a few years, but Epstein is such a persuasive storyteller that she earns a serious hearing. To illustrate what's needed, Epstein draws an analogy to the medical activ-ism of women's groups in nineteenth-century America. Once they understood the germ theory of disease, they were able to spread habits of hand washing, covering your mouth while coughing, not spitting in public, etc. This successfully reduced disease even before the invention of antibiotics. The Ugandan AIDS activist Beatrice Were told Epstein: As a woman living with HIV, I am often asked whether there will ever be a cure for HIV/AIDS, and my answer is that there is already a cure. It lies in the strength of women, families and communities who support and empower each other to break the silence around AIDS and take control of their sexual lives. In Epstein's words, "When it comes to fighting AIDS, our greatest mistake may have been to overlook the fact that, in spite of everything, African people often know best how to solve their own problems." Alas, as Epstein notes, this "Invisible Cure" is unlikely to commend itself either to big-budget Western AIDS programs or to the bureaucrats and consultants who are committed to them. The cure Epstein describes can't be carried out by a World Bank strategy; it can't be bought by aid dollars, or put on a billboard. But perhaps, by reading her book, AIDS International will learn a lot about what not to do. Maybe Epstein's account of the dangers of multiple long-term partners will be more widely understood and decrease some of the stigma and denial that have hampered frank discussion of AIDS in Africa. Maybe some politicians and citizen activists in both the West and Africa will dare to challenge the wall of silence surrounding the spread of AIDS. And maybe, through research and experiment, some well-meaning Westerners will find a way to reinforce the homegrown "Invisible Cure," and to make it more likely to happen sooner rather than later. Just read The Invisible Cure. If you do, you will be mortified that such an epic tragedy has found so few heroes and so many opportunists and bumblers. And you'll hope that someone will do better next time. Except that this particular next time is already here. Notes [1] And the Band Played On: Politics, People, and the AIDS Epidemic (St. Martins, 1987). [2] UNAIDS report, December 2006. [3] Bekki J. Johnson and Robert S. Pond, AIDS in Africa: A Review of Medical, Public Health, Social Science and Popular Literature (Aachen: MISEORE, Campaign Against Hunger and Disease in the World, 1988). [4] Jill Armstrong, "Socioeconomic Implications of AIDS in Developing Countries," Finance and Development, Vol. 28, No. 4 (December 1991), pp. 14-17. [5] World Bank, Africa Technical Department, "Acquired Immunodeficiency Syndrome (AIDS): The Bank's Agenda for Action in Africa," October 24, 1988. [6] Some treatment advocates claim that HIV testing and treatment themselves have preventative effects, but Epstein notes that there is little evidence to support this politically convenient claim. [7] Letter to PEPFAR partners from Ambassador Eric M. Bost, Embassy of the United States of America, Pretoria, South Africa, January 26, 2007. [8] The World Bank's Global HIV/AIDS Program of Action, December 2005. -------------------------------------------------------------------------------- 2.Transcending God God Is Not Great: How Religion Poisons Everything by Christopher Hitchens Twelve Books, Hachette Book Group An Interview with Christopher Hitchens from The Atlantic ~ July 12, 2007 I happened to catch you on Hardball last night with Al Sharpton. There was quite an atmosphere. I like these outdoor things with the crowd and the heat and so on. But what a clown the guy is-a vulgar clown. I also followed your debate with him at The New York Public Library. He made the argument that your book should have been called Organized Religion Is Not Great rather than God Is Not Great, since your issue is with the structures of religion, not with actual faith in the Divine. I think we can say with reasonable certainty that there is no God because all the hypotheses for it have been exploded or abandoned. We have better explanations for the things religion used to try and explain. But we can't disprove the existence of a deity. So if someone says, "Well, I just feel the presence of a strong force"-well, okay. I sort of know what they're going through. As long as they don't try to teach it to my children, or get the law changed to suit their opinion, or blow themselves up at the airport. I've learned a lot from doing the tour, because I've had a debate with some religious person at every stop. What I haven't had from anyone, in print or in person, is any argument that surprised me, that I couldn't have completely predicted. But were you surprised by arguments they didn't make? You seemed taken aback by how much Sharpton agreed with you on certain issues. I debated a guy named Mark Roberts, Hugh Hewitt's choice of pastor. Hewitt is a major Christian broadcaster and he said, "I'm going to put up a champion against you." I said, "Bring it on!" So I asked this guy, Roberts, "Do you believe St. Matthew when he describes the crucifixion and says all of the graves of Jerusalem opened and all the corpses walked around greeting their old friends?" And he answered too quickly. He said, "Yes, I do, of course I do. I'm a Christian-I have to believe it." But he added, "As a historian, I'm not absolutely sure." I said, "Thanks for that. I must say, it's the most incredible answer I ever heard." The guy spent half the time saying that a great deal of what I wrote in the book is right. Several of them have done that. Which is enjoyable. Is it enjoyable, though? Or do you secretly find it disappointing? Well, you sometimes feel as if you're punching the air. You wish they'd say, "No, excuse me, John Calvin was right, and you're going to hell, buster." But they don't do that. They won't do that in front of an intelligent audience. They may privately think it, but they don't bloody say it. And I know quite a lot about what they believe. There was one guy in Illinois who was a professor of theology and an ordained minister. He said, "You know, I was amazed. You had things in your book about our beliefs that I thought only a few people knew." He said this on the air on Christian Science Monitor Radio. I thought, "This is becoming disappointing. Why can't I get someone to stand up and say, 'Yes. Of course there was an impregnation of a Palestinian virgin by the Divine 2,000 years ago, and that proves the truth of Christ's doctrines. And not only that-he died for your sins. And if you don't acknowledge this, you've missed your chance of going to heaven, and you've doubled your chance of going to hell.'" No one will do it. What about the question of morality without God? Al Sharpton spent a lot of time grilling you on that. And it was also a major theme in your email debate with the Christian author Douglas Wilson at Christianity Today. Weird guy. Wilson insisted that if you took Jesus out of the equation, the words "right" or "wrong" would have no meaning. Thoughts in the brain would just be a series of chemical reactions, like bubbles in a soft drink. As he put it, "If you were to take a bottle of Mountain Dew and another of Dr. Pepper, shake them vigorously, and put them on a table, it would not occur to anyone to ask which one is 'winning the debate.' They aren't debating; they are just fizzing." What he's saying is that if he ceases to believe in Jesus, he's going to instantly become an immoral person. It's a terrible admission to have made! It's an awful insult to human self-respect to say that. And they don't seem to understand that they give themselves over in that way. It's like saying that nothing would stop me from raping you now if I weren't under the supervision of a heavenly dictator. And I have a higher opinion of myself than that. Are you suggesting that you have more faith in human nature than religious people do? Well, I'll put it this way: you can certainly say belief in God makes people behave worse. That can be proved beyond a doubt. Whether it makes them behave better or not, I don't think is so easy to prove. Because you can't be certain that their belief is what made them dive in front of a truck to save a child's life. They might say, "I did it for Jesus," but they might have done it anyway. I'm not so sure about that. I know Mother Teresa isn't your favorite... Oh, well, that's easy! All the wicked things she did... But her nuns were willing to pick lepers off the street, to devote their lives to the people no one else in society would touch. And they seemed to do it with genuine respect and dignity. I know people who do that. I've been to Uganda and to North Korea and to Eritrea, countless horror spots around the world. Everywhere you go, you meet volunteers who are giving up their lives for other people. Most of them are secular. I don't think that proves anything about secularism. But the ordinary action of helping a fellow creature in distress doesn't require faith at all. It just doesn't. However, the evil things missionaries do are definitely done because of religion. When Mother Teresa said abortion and contraception were equivalent to murder and were the greatest threat to world peace-nobody could have said anything with such wicked consequences! She tried to demolish the only cure for poverty that we know for sure exists, which is the empowerment of women. I'm not particularly a feminist, but if you get women off the animal cycle of reproduction and give them some say in how many children they'll have, immediately the floor will rise. And if you throw a handful of seeds and some credit to these ladies, the village will be transformed in a couple of years. Mother Teresa spent her entire life trying to make that impossible. I would say that millions of people are much worse off for her efforts. On an Irish radio show on a recent Sunday morning, I said, "I wish there was a hell for the bitch to go to." You couldn't have said that a few years ago. You would have gotten a terrible pasting for it. But now, everybody knows it's true. They see through this stuff. One complaint you've gotten a lot is that you lump all religious people together, throwing the moderates in with the extremists. What's your opinion on Unitarians, for instance? They say Unitarians believe in one God maximum. And they do produce the Jefferson Bible. They keep it in print. Good. I once read that only six percent of Unitarians consider God to be their primary religious motivation. Most of them are more focused on social justice and community service. I've spoken at Unitarian churches very often. It seems to me, again, that they don't give me enough to disagree with. But as for lumping them in, I'll say this. Have you read Camus's La Peste? At the end, the plague is over, the nightmare has dissipated, the city has returned to health. Normality has resumed. But he ends by saying that underneath the city, in the pipes and in the sewers, the rats were still there. And they'd one day send their vermin up again to die on the streets of a free city. That's how I feel about religion. Thanks to advances of science, education, political tolerance, pluralism and so on, religion can now be one option among many-who cares who's a Unitarian or who's a Congregationalist? But in the texts, the actual texts, there is always this toxin that's ready to be revived. What I say is, "Do you believe this stuff or don't you?" In other words, "In what respect are you different from a humanist?" The authority of the texts is always on the side of the extremists, because they do say what they say. So be aware of this danger. That's all I'm arguing. But if religion is a human invention, can't people reinvent their religion? Don't people have the power to infuse new meaning into old words? Yes. I realized on this book tour that I would have to write a different book for every person I met, because they all take religion a la carte. I mean, sure. No two people see the world in exactly the same way. This is further proof that it's manmade. The fact that everyone has now the right to invent their own creed is a point for me rather than a point for them. Reform Jews do believe that the Bible was written by humans. Should Reform Judaism still be called a religion? Well, that's honestly what I wonder, whether it should be in that case, or whether it's just a social club. There, I almost sympathize with the people who say, "Well, it's not heresy, but it's just another name for hedonism or believing whatever you like." I'm okay, you're okay-that's not a religion. Religion is saying that you know the mind of God and you want to obey His revealed commandments, on pain of losing your soul, at least. People who really live their lives in fear of that-God-fearing, as they used to say-I can respect. People who are somewhere between Unitarianism and Reform Judaism-it just seems weak-minded to me. Why bother? You mention in the book that some of your most interesting conversations are with religious friends. What do you talk about with them? My friend Christopher Buckley and I have been discussing religion on and off for years. He's had all kinds of fluctuations with Catholicism. He's through with it now. But giving it up was no light matter. We had some very serious discussions about it. And if I want to borrow a book-any book-that I don't have myself and need to get hold of quickly, there's a very ultra-Orthodox Jewish couple in this apartment building, a few floors below me, who would be very likely to have it. They're highly intellectual, very well read. They'd also be very interested in having a discussion about the book before I gave it back. I'd just have to be careful not to call them on a Friday night because they wouldn't answer the fucking phone. Most of my Jewish friends are, like most Jews, non-believers-in fact, very discerningly secular. But these two are very observant. I wouldn't say very devout, but it means something to them. It's the continuity of the tradition. I'm not indifferent to that. Not at all. It's funny you should mention that, because when I read about your religious crisis at the age of nine, I found myself wondering if you would have been happier in a yeshiva, where you could have questioned everything and analyzed texts to your heart's content. My own way of joining a yeshiva was to become a Troskyite, I suppose. I was a member of an extremely Talmudic sect. The leading thinker of our group was a guy called Yigael Gluckstein; he wrote under the name Tony Cliff. There was a very heavy Jewish presence in this group, too. You realized that for many people this was a kind of substitute for the yeshiva. They loved the micro-arguments within Marxism about the nature of the Soviet state: the different theories of bureaucratic collectivism, state capitalism, workers' status-absurd as these discussions would seem to outsiders, absurd as some of them actually were! Yeshivas were very good training, no doubt about it. I use the word "fundamentalist" as a dismissive term, but actually, those who really struggle with the text, and try and make it come out right, have my respect in a way. Grudgingly. I think it's sinister, but people who are willing to give a bit of their life to this, to their Torah portion or their Sura-it's better than breezing along like some nihilist or hedonist. At the very least, that approach to religion requires a lot of thinking. As one Orthodox rabbi once said to me, "No Jew is infallible. Only the Pope is infallible." My favorite time in the cycles of public life is the time when the Pope is dead and they haven't elected a new one. There's no one in the world who is infallible for those weeks. And you know, I don't miss it. There's one thing I have to ask you about. You mention in the book that Orthodox Jews have sex through a hole in a sheet. As far as I know, that's an urban legend. You should see the email I got from my downstairs neighbor about it! I asked him, "Look, someone's told me this is an urban legend. There's a film about it, there's a book about it. How come only now, when I mention it in passing, does it suddenly become such an issue?" His email was wonderful-about three pages worth-including the possibility that some mad rabbi in some shtetl maybe did say something like that. But I've changed it. It's not in the book now, not in the new editions. And I wish I hadn't put it in. It was absolutely in passing, and I didn't need it. When I think of the mikvah, and other Orthodox teachings about women, some of them very obscene, I could have made it much harsher. Ironically, you've learned a lot about religion in the process of writing this book. And religious people seem more than happy to engage with you about it. That is actually what impressed me with all these debates on my book tour. I have had almost no refusals. Initially in Atlanta, my publisher said, "We've given up. We won't get anyone. We might not even get a hall in Georgia to do this." And I said, "No, I bet you we will. They won't want it said that they refused the challenge." And actually, they were pretty generous in the end. According to the Wall Street Journal, you've been selling a lot of books in the Bible Belt. And I promise you, there was no stop where we didn't have to turn hundreds of people away. Who were these hundreds of people? Were they atheists? Were they religious people who were angry at you? No, definitely not. They are people who have had enough. Particularly in the South, they're people who don't like being laughed at by people from the North who think they're all rednecks and Falwell fanciers. They're very clear on that. They regard that association as a fucking insult, which it is. Falwell died the week of my swing through the South, making me wonder if someone up there really does like me. So I had to mention it, and I said what I thought about him, and it brought roars of applause. Even the things I said about him that were really, by any standards, quite rude, while the guy's carcass is hardly cold. Just look at what's happened to so-called intelligent design-the Creationist movement. It's been defeated in every court where it's been tried-in Oklahoma, Kansas, Texas, the most conservative district in Pennsylvania around Dover. They've been smashed. People don't want to come from a state they'll get laughed at for saying they're from. From what I've read, the judge in the Dover case was actually quite religious himself, which raises another question. There are millions of religious people who would say, "Look, we completely believe in science. But yet, we also have this separate part of our lives that is about ritual and family and personal meaning." Are you fine with that? Sure. Those people meet my qualifications. They make it a private belief. The place for religion is in the mind, within the individual. If they insist, it's within the family, as long as they don't abuse the children. There are lines they shouldn't cross: no genital mutilation of people who aren't qualified to sign an elective surgery form. No, not once, not ever. Preferably, no teaching about hell, I think. But you probably can't stop people from doing that. No denial of medical care on superstitious grounds. Straight to jail for that. No marrying off your daughters to distant relatives, or not so distant, like the Mormons do. Last week, I was at Salman Rushdie's 60th birthday party in London-he was celebrating his knighthood. It was quite a nice evening. Anyhow, I met an interesting Pakastani novelist named Nadeem Aslam. He's from the Yorkshire towns where a lot of Pakistani Muslims have settled, which is now the hotbed of terrorism in Britian. And he says that something really terrible has happened in this community. Because of their tradition of going back to Pakistan to the same old village, in the most backward part of Pakistan, to get a wife from the tribe and bring her, veiled, back to England, this percentage of the population is responsible for the majority of the deformed births in the country. They're inbreeding. They're ruining themselves and creating a huge burden for the health and social welfare departments as well. It's obscene cultism. That bothers me, too. That's influencing the society I'm living in. How's Rushdie doing? There's been quite a stir surrounding his knighthood. He's fine. There was an attempt to jack it up, but it has failed. He was afraid at one point that it would happen again, as it happened before in '89, that in one of these shops in Pakistan, the police would go nuts and kill a few people. And then the whole thing would take off and there'd be more blood spilled. It didn't happen, though. He stayed right here in this apartment when he was still under the fatwa, didn't he? He did, yeah. That was when he was on the run. The whole of this front area was a command post with machine guns and dogs and searchlights. There were four hotels that look into this apartment, and they had rooms in each of them. By "they," you mean the Secret Service? It was the Diplomatic Protection Corps. He'd come to visit the White House, so he had to be protected on their dime. They said it was the toughest job they ever had to do because when the Chancellor of Germany is in town, everyone knows she's in town, so your protection of her doesn't draw attention to her presence. But they wanted maximum protection- -and they didn't want people to ask, "Why are those guys with machine guns standing in that courtyard?" Yes. Although it got out. Maureen Dowd leaked where he was staying. Thanks a lot. * *From the editor: Maureen Dowd denies this, and The Atlantic erred in not seeking her response before posting this interview... Click here for more You mentioned that religion should be a private affair. Where do you stand on the headscarf debate in France? There is in fact no mandate in the Koran for covering the head or the face. In many countries that have a Muslim majority, there's no question of girls wearing veils in school. Turkey wouldn't have it, Tunisia wouldn't have it, I don't think Morocco would have it. We're applying a Saudi standard to children in Western Europe because we think we must respect their religion. And it's a Jewish heresy, covering the hair, which you'd think would put them off. But no, they always borrow the worst stuff. They borrow the dumbest stuff in Judaism: the terrible Abraham story and the pork phobia and the head covering. They also borrow the stupidest stuff from Christianity, like the virgin birth and all that nonsense. It's awful, witless plagiarism. Why we should respect it, I don't know. You seem to enjoy talking about the virgin birth. It comes up quite a lot in your book and your debates. I was on the radio with some talk show host in Seattle who turned out to be Catholic. I found it out this way: I said, "Find me anyone who believes in the virgin birth. I just don't believe anyone believes in it." And he said, "I do." I said, "No you don't. No you don't, you're just saying it!" And he said, "Yes, I do. I believe in the immaculate conception of Jesus Christ." And I said, "I hate to tell you this, but the immaculate conception of Jesus Christ is not the same as the virgin birth. The immaculate conception is the conception of the Virgin Mary. She was immaculately conceived, because she had to be conceived originally without sin. It's a quite different thing from the virgin birth." There was a slight pause. I said, "Well, so is there anything else you truly believe while we're at it? You've been believing that when it's not the teaching of the Church. You probably would have believed in limbo when they told you to. Now they tell you you don't have to. What if the teachings change again? It's nonsense! It's come to something when I have to tell you what the Catholic teaching is on births and conceptions." (Editor's Note: Buy The Atlanitic for the complete interview). -------------------------------------------------------------------------------- B Upcoming Conference The Drug Policy Alliance's International Drug Policy Reform Conference is the world's principal gathering of people who believe the war on drugs is doing more harm than good. No better opportunity exists to learn about drug policy and to strategize and mobilize for reform. December 5-8, 2007 New Orleans, LA -------------------------------------------------------------------------------- C Quotes The man of knowledge must be able not only to love his enemies but also to hate his frriends. - Friedrich Nietzsche I'm not really religious but very spiritual. I give money to this company that manufactures hearing aids on a regular basis. More people should really hear me sing. I have a gift from God. - Christina Aguilera Freedom is about authority. Freedom is about the willingness of every single human being to cede to lawful authority a great deal of discretion about what you do and how you do it. - Rudy Giuliani -------------------------------------------------------------------------------- D How To Help The Harm Reduction Project is able to provide services through the support of individuals such as yourself. Please help us make a difference and pledge your support today! PLEASE CLICK HERE TO DONATE or call 801-355-0234 ext 3# for more information. --- About HRP The Harm Reduction Project works for the enhancement of services available to marginalized populations HARM REDUCTION PROJECT SALT LAKE CITY | DENVER | WASHINGTON D.C. TEL (801) 355.0234 FAX (801) 355.0291