HIV Criminalization: A Thorn in the Side of Public Health Prevention by Lydia Karch

Full disclosure: my first White paper looked at criminalization of HIV in the U.S. Given that I work and study in the field of public health, I am going to use this blog post to focus on some of the public health implications of criminalization, rather than the ethics or morality of criminalization itself, topics that I think other people may be better equipped to handle.

The Positive Justice Project (PJP) at the Center for HIV Law & Policy has compiled a (non-exhaustive) list of 134 prosecutions and arrests for HIV exposure in the U.S. from 2008 to the present. [1] The most recent case is from Florida, where a prostitute under arrest admitted to testing HIV positive; notably, the coverage of her arrest does not mention whether she was receiving anti-retroviral therapy (ART) or using condoms in her line of work. [2] The woman is currently facing a felony charge for failing to inform her partners of her HIV status, although one assumes since both her name and picture were published with the story, past and present johns have had ample opportunity to inform themselves.

The majority of United States HIV criminal cases involving sex also neglect to report or consider condom use and ARVs (both of which significantly reduce the risk of transmission), and spitting or biting continue to be “hazardous” behaviors worthy of arrest and felony prosecution. The Kaiser Family Foundation’s 2011 Survey of Americans on HIV/AIDS further underscores a seemingly entrenched ignorance about HIV transmission: 1 in 4 Americans believe (or do not sufficiently doubt) HIV can be transmitted via a shared drinking glass, 1 in 6 believe the same for toilet seats, and a little more than 1 in 10 view swimming pools as a potential source of infection. [3] In contrast, the Centers for Disease Control and Prevention (CDC) website on HIV Transmission dismisses saliva alone as a potential means of transmission, and reports that all known cases of HIV transmission via biting involved severe trauma, extensive tissue damage, and blood; bites that do not break the skin have no chance of transmitting HIV. [4]

A major public health concern with criminalization is that it perpetuates and reinforces myths or misperceptions of HIV risk and transmission. When an HIV-positive man or woman is charged with a felony for spitting on a police officer, despite the CDC’s official position against spitting as a feasible transmission route, it sends mixed messages about what “risky” behavior truly is, and forces the public to choose which authority they will listen to. Additionally, high profile cases fuel stigma and fear of HIV-positive people, which in turn may (although there have not yet been any studies to support this theory) inhibit testing and disclosure. Patients who fear being judged, shamed, or accused of a crime may be less willing to engage in counseling, or truthfully report sexual practices to health practitioners. [5]

Criminalization also shifts the responsibility for safe sex onto just one partner, a dangerous assumption given that unsafe sex can lead to any number of STIs or an unintended pregnancy, not just HIV [6]. In other words, sex carries risks under any circumstances, not just in situations where one partner is HIV-positive. Placing the burden for safe sex entirely on the HIV-positive person’s shoulders is unjust, and can not only reinforce stigma but also cultivate complacency among HIV-negative persons. Safe sex is every person’s responsibility. Unfortunately, having just asserted the importance of equal responsibility for safe sex, it is impossible to ignore the harsh reality of gender inequality. Women are more at risk for coerced, unprotected sex in societies where they also suffer from social, economic, and political disempowerment. Women who are HIV-positive but unable to refuse sex do not deserve to be criminally prosecuted; nor do mothers who are uninformed or unsupported in attempting to prevent mother-to-child transmission. [5] Assuming autonomous, let alone intentional, sexual decision-making runs the risk of further victimizing already vulnerable populations.

As Judge Cameron notes, “In the majority of cases, the virus spreads when two people have consensual sex, neither of them knowing that one has HIV. That will continue to happen, no matter which criminal laws are enacted and which criminal remedies are enforced.” [6] The real crime in evidence here is ignorance (of status, prevention techniques, and transmission routes), which is best addressed through evidence-based public health outreach, education, and support for testing, counseling, and treatment.

 

 

Sources

[1] Positive Justice Project (PJP). Prosecutions and Arrests for HIV Exposure in the United States, 2008-2012. 14 Feb. 2012: http://www.hivlawandpolicy.org/resources/view/456

[2] Ritchie, R. Michelle Weissman busted in prostitution sting, tells deputies she’s HIV positive, police say. wptv.com, 8 Feb. 2012: http://www.wptv.com/dpp/news/region_c_palm_beach_county/lake_worth/michelle-weissman-of-lake-worth-busted-in-prostitution-sting-tells-deputies-shes-hiv-positive#ixzz1mOEu3Rwg

[3] Kaiser Family Foundation (KFF). HIV/AIDS at 30: A Public Opinion Perspective. June 2011: http://www.kff.org/kaiserpolls/8186.cfm

[4] Centers for Disease Control and Prevention (CDC). HIV/AIDS, Questions and  Answers: HIV Transmission. 25 Mar. 2010: http://www.cdc.gov/hiv/resources/qa/transmission.htm

[5] Jürgens R, Cohen J, Cameron E, Burris S, Clayton M, Elliott R, Pearshouse R,

Gathumbi A, Cupido D. Ten reasons to oppose the criminalization of HIV exposure or transmission. Reproductive Health Matters, 2009; 17(34):163-172.

[6] Cameron E. Criminalization of HIV transmission: poor public health policy. HIV/AIDS Policy & Law Review, 2009; 14(2):62-75.

Emerging Challenges in Increasing Access to HIV/AIDS Medicines by Daniel Hougendobler

I had the opportunity to work at the Medicines Patent Pool last summer.  From my work at the Pool, meetings and conferences I was able to attend, and conversations with various individuals, I was able to learn about some trends and challenges facing the Pool and access to medicines in general.  I wanted to share a few of these.

Access to medicines in middle-income countries

When the Medicine Patent Pool’s first license with a pharmaceutical company, Gilead Sciences, was signed, it sparked a deluge of comments from NGO’s and civil society groups.  The reactions generally fell into two categories.  First, many expressed gratification at what the license represented and the promise of increasing access to Gilead’s products. 

However a sizeable number expressed displeasure at some of the specific terms in the license.  The problem for many was that the license excluded those in middle-income countries, where most of the world’s poor currently live.   This is likely to represent a source of considerable tension moving into the future.  While it is relatively easy for a pharmaceutical manufacturer to write off the market in Gabon or Burundi, it is far less likely that they will do so in Brazil, India, China or South Africa, which they see as huge sources of future revenues.  Unfortunately, a large proportion of people in these middle-income countries still live in dire poverty, little better than those in most developing countries.  The debate over access licensing in middle-income countries is unlikely to be resolved easily or soon.

“TRIPS-plus” FTA’s

Another important issue that has been present since TRIPS was passed, but has become increasingly in the spotlight in the past few years, are “TRIPS-plus” agreements, which are generally free-trade agreements.  Two prominent current examples are the Anti-Counterfeiting Trade Agreement (ACTA) and the India-E.U. FTA, which have been criticized for attempting to introduce provisions imposing onerous data-exclusivity requirements, civil trademark enforcement mechanisms without a requirement of intent, cross-border seizure, and extreme punishments for IP violations. 

With political consensus for stricter IP rights having largely evaporated from international organizations such as WTO and WIPO, access battles are increasingly being fought bilaterally.  This imposes special challenges to those who want to insure access is being protected since even the existence of these negotiations is often kept secret.

Treatment 2.0 

We’ve touched on this in class, but the concept of Treatment 2.0, or Treatment-as-Prevention, is having a profound effect on the access to medicines community.  This has muted an often-contentious debate between those advocating for treatment vs. prevention and has increased the demand for treatment.  It means that access to ART is an increasingly important tool in the fight against HIV/AIDS.

Confronting budget constraints

With vital programs such as PEPFAR and the Global Fund facing increasingly severe budget cuts or instability—and with the probability of this trend continuing into the foreseeable future—the access to medicines community has to find creative ways to provide more treatment with fewer funds.  The shift from a single focus on HIV has become (rightly, I believe) a more diffuse effort to address diseases and conditions that effect resource-limited settings (e.g. the shift in U.S. emphasis from PEPFAR to the Global Health Initiative).  However, this means that achieving the level of access to ART necessary to end the pandemic will require creative strategies, more funding, and lower prices, particularly for second- and third-line ART, which will become increasingly important as people in resource-limited settings live longer. 

Are AIDS Medicines Public Goods? by Zhibin Dai

In basic terms, a public good is defined by two characteristics: 1) non-rivalrous, meaning that the use of a good by one person doesn’t decrease the availability of the good for other people, and 2) non-exclusive, meaning that no one can exclude another person from using the good. A very basic example is air. One person breathing in air doesn’t make air any less available for other people, and an individual cannot effectively exclude other people from breathing air. Other examples could be national defense and public roads (public goods are generally provided by the government).

Pharmaceutical drugs are typically not public goods; drug manufacturers can exclude people who cannot afford the cost of the drug from having access to them. But in the context of the global AIDS epidemic, the moral quandary of denying people access to life-saving drugs because they cannot afford them throws this traditional framework into question (although it’s only a moral quandary because the aggregate wealth in the world is enough to afford life-saving drugs for anyone who needs them). Hoen et al discuss this issue in “Driving a Decade of Change.” The paper addresses the tension between enforcing pharmaceutical patents globally while also making life-saving ARVs available to patients in developing countries.

Hoen et al outline the efforts that governments, international organizations and NGOs have taken to increase access to drugs. These include applying public pressure on pharmaceutical companies to sell licenses to generic manufacturers in countries such as India, as well as delaying the implementation of patent protection in developing countries. The authors also advocate for a global Medicines Patent Pool that would coordinate and streamline the selling of patent licenses for developing nations.

The efforts outlined by Hoen et all clearly suggest that globally, AIDS treatments are increasingly viewed as public goods that should be available to anyone who needs them, regardless of whether they can afford them. Going forward, the question is: what is the best framework for providing life-saving AIDS treatments to those who need them?

Ideally, pharmaceutical companies would just give these drugs away to patients who need them to survive but can’t afford to pay for them. In theory, this wouldn’t really hurt drug companies that much because the costs of actually manufacturing the physical drugs is low – most of the costs are front-loaded into development and regulatory approval –  and since the patients can’t afford them anyway, the drug companies, in theory, were never going to make revenues selling the drugs to them.

However, giving drugs away in poor countries could be used by drug companies as an excuse to charge higher prices in developed countries, which would essentially turn the increased prices into a form of foreign aid. Another incentive for drug companies to raise prices in developed countries while giving drugs away in poor countries is that, in giving drugs away, companies are closing themselves out of major markets because the vast majority of AIDS patients are in poor countries, particularly Africa. I’m ambivalent about whether this would or does happen, but given that drug companies can charge monopoly prices in the United States and Western Europe, they certainly could.

In terms of patent protections in developing countries, it seems that the ideal solution would be to grant strong patent rights as a baseline and then work with them to create exceptions in situations where it’s socially necessary. This seems to be the approach of the patent pools. This protects drug companies’ investments because a significant number of the drugs they develop are not lifesaving, and as such, should not be treated as public goods. If Pfizer wants to charge super-high prices for Viagra in the developing world, they should be able to. Another issue is which countries loosened patent protections should apply in; there are major wealth discrepancies between developing countries. China and Zimbabwe are both “developing”, but the former is flush with cash while the latter is in pretty dire straits.

Week 12: Vertinsky & Kocher

Week 12 focused on  HIV/AIDS and the law.

Liza Vertinsky from the Law School talked about patent pools that have been developed in an effort to bring down prices and increase accessibility to HIV/AIDS drugs in developing countries. A student in the class, Catherine Perez, posted this great video that helps simplify the rather complex process. Paula Kocher from the CDC talked about the ins and outs of partner notification programs (also called “contact tracing”). She also discussed the criminalization of people with HIV/AIDS who infect others and the treatment of HIV+ prisoners.

Reading:

• Butler, Declan & Natasha Gilbert. “Drug Patent Plan Gets Mixed Reviews.” Nature. Vol. 457, No. 26. February 2009. 1064-1065.
• Zimmeren, Esther van. “Patent Pools and Clearinghouses in the Life Sciences.” Trends in Biotechnology.  Vol. 29, No. 11, November 2011. 570-576.
• Hoen, Ellen T. “Driving a Decade of Change: HIV/AIDS, Patents, and Access to All Medicines for All.” Journal of the International AIDS Society.  14:15, 2011. 1-12.
• Gostin, Lawrence O. “Piercing the Veil of Secrecy: Partner Notification, the Right to Know, and the Duty to Warn.” AIDS Pandemic: Complacency, Injustice, and Unfulfilled Expectations. Chapel Hill: University of North Carolina Press, 2004. 167-178.
• Gostin, Lawrence O. “The Criminal Law: Knowing or Willful Exposure to Infection.” AIDS Pandemic: Complacency, Injustice, and Unfulfilled Expectations. Chapel Hill: University of North Carolina Press, 2004. 185-198.

 

link to some international AIDS education campaigns

http://tusb.stanford.edu/2007/04/hivaids_awareness_ads_youll_re.html

 

Narratives and Youth by Catherine Perez

“Making Sense of Condoms”

            This article was about studying the views on condom use by African youths. And I do consider that an important inquiry, since condoms are a great way to help prevent HIV transmittance. With the way HIV is being spread rapidly and among youths (stated in the article was 45% which is almost half!), assessing condom use attitudes can be a way to figure out how to get youths to use them. Since sure we can say that condoms are one of the best ways to prevent HIV transmittance, but the fact remains people need to use them. They need to use them right, consistently, and every time in order to be really effective.

I thought it was interesting to use a script writing contest to gauge youth’s perspective on the use of condoms. I feel like just asking youths would be more direct, and less bias to people who actually entered a contest to win a prize. To me the data would be skewed (but hey what data isn’t anyway?), but in the article the authors mention how the skits show youth’s perspectives in a free imaginative way. It allows youths to use their knowledge of firsthand experiences and to interpret their personal culture into skits for their community. So these narratives are great, but since to me it’s a contest, I don’t think they can be that accurate of a representation. I believe the ideals in these narratives are held by youths, maybe even commonly, but I thought this research wanted to access a more quantitative approach, as this would be useful in knowing what the majority of teens thought about condom use, but the research was more focused on the qualitative aspect.

According to the article 63,000 people participated in this contest and I was surprised that that many people entered. It was also interesting to hear some of the differences in the skits, for example between genders and ages. In the article they said condoms were only mentioned in around 37% of the samples they had, which to me seem pretty low.

So reading the 1^st article second, I thought it was cool that these skits brought a difference to a select few’s lives. It allowed one to live their dream of directing films and it gives a way for people to relate.

They also mention that they saw misconceptions and themes in the entries, which sparked the (above) other article. So its troubling that misconceptions exist, but if people know the problem, they can better fix it.

So overall between the two articles, I’m glad that these narrative contests work in many ways. It allows youth to express themselves and win a prize, plus it gives data to researches about what youths think about HIV.

—Catherine Perez

(^-_-^)

Scenarios Program by Amy Stein

Both articles have made it extremely clear that condom use is imperative for the prevention of HIV.  Since young people are the majority of the population who has newly contracted HIV, they are the generation that needs to be targeted when it comes to condom use. The Scenarios program is brilliant and evidently effective because this program specifically targets young people. Since teenagers and those in their 20’s are so immersed in media, Scenarios is the perfect way to target the intended audience. I find the wide range of participants involved in the Scenarios program particularly compelling. The idea generated by a single participant flows through so many different people that even if an entry is not chosen, it is still read, analyzed and interpreted by others involved in the process, which can still leave an everlasting effect. It is the collaboration between the creators, the organizers, the PLWA etc. that make this program unique. Also, I enjoy the fact that young adults create the films because it creates a stronger connection. For instance, if an adult created a film aimed at teens regarding AIDS prevention, they can attempt to incorporate mainstream ideas associated with youth culture, but it’s completely different than an attempt made by an actual youth. When a teenager or young adult creates an idea for a film about AIDS, there will be a certain aura about it, and they know how to attract and reach the audience because THEY are the audience. Sex could be an awkward topic to discuss sometimes, when it is presented in a humorous way, while also relaying extremely important knowledge, of course teenagers will listen. A fun project for this class (if it continues next year) would to create a video or film, similar to “The Shop,” that incorporates vital information about AIDS in a modern, yet informative way. I feel that if high school students watched a video on AIDS prevention, but it was funny, and incorporated pop culture aspects such as Face Book or Bono, they would listen and definitely learn.

Condom use and the age old battle of the sexes by Cassy Novick

Two comments about the articles:

One of the results of the “Making Sense of Condoms” really caught my attention:

“As a rule, female authors tend to place greater emphasis on the agency and vulnerabilities of female characters by means of plots in which they avoid infection by refusing to have unprotected sex or are infected as a consequence of their failure or inability to negotiate condom use. Male authors tend to focus more on their e primarily male e characters becoming infected when they refuse to believe in HIV or to heed the advice of friends” (Winskell 2011)

This observation is representative of greater trend in the “battle of the sexes” if you will. Women are more likely to ask a man to use a condom than a Man is to initiate condom use on his own. This difference in a behavior I believe to be a result of difference in cost and benefit. Getting pregnant comes at a higher cost to women than it does to men. Assuming that a woman has a hard time communicating her preference to use a condom (which is often the case) we have a situation that is well represented by a coordination problem referred to as “the battle of the sexes” in public choice theory (see utility diagram below)

 

Battle of the Sexes	Woman
Man		Condom	No Condom
	Condom	1, 2	0, 0
	No Condom	0, 0	2, 1

According to public choice theory, this is a coordination problem in that the man and the woman get more benefit out of coordinating than not (both choosing a condom or not choosing a condom), but the woman has a higher utility for wearing a condom than a man and vice versa. In attempt to maximize utility, the two end up not coordinating because the woman will choose/prefer condom and the man will choose/prefer no condom resulting in less benefit than if they have coordinating. This coordination problem can be resolved by communicating one’s preferences.

One other thing i meant to post, but apparently it didn’t make it through the cut and paste process is the following (might be a good addition to your comments)….

What I found interesting in relation to the article “Scenarios in Africa” was the role that cinema in relation to our own reality. Cinema, TV, Video Games, and all other types of screen entertainment have been proven to impact our everyday lives in many ways ranging from prevalence of violence in children who watch too much violence to Robert Putnam’s analysis of the affect of TV on Social Capital. With what we see on the silver screen becoming increasingly realistic with digital effects, 3D, and surround sound promoting the illusion of reality. Taking this into account and Robert Putnam’s theory on social capital I feel like the following could be true:

According to Putnam, the rise of TV has resulted in a decrease of social capital (aka people join less teams and social organizations and more often “bowl alone”). This lack of social capital is naturally connected to less connectivity and less healthy/numerous physical social relationships (no how many friends you have on facebook is not a gauge of how many social relationships you have). With less healthy social relationships, we communicate more poorly, which could explain why the preferences over condoms are not communicated. Furthermore (this may be a stretch but here it goes) less healthy social relationships encourage more ideas of “friends with benefits”, one night stands, and even prostitution. In these arguably unhealthy relationships the necessary dialouge about condom use is likely to not take place. So the lack of communication over condom use is not just an archaic form of paternalism, but a modern disregard for substantial, healthy social relationships. So I pose the question: Does facebook help or hurt or social structure? we may reach more people, but do we reach these people with more shallow interactions and connections?

Week 11: Winskell & Von Mueller

This week Kate Winskell from the School of Public Health and Eddy Von Mueller from Film Studies talked about representations of HIV/AIDS in film.

Winskell talked about her project her film project Scenarios from Africa which “gives children and young adults an exciting opportunity to educate themselves and others about HIV/AIDS by inviting them to participate with internationally acclaimed directors in the production of a growing collection of short films.” My favorite that we watched is called Tiger, Tigress. You can watch it here: http://www.youtube.com/watch?v=XE5BKU9aJCg

Von Mueller juxtaposed two movies released in 1993 that center on the lives of HIV+ gay men: Philadelphia starring Tom Hanks and Denzel Washington and directed by Jonathan Demme and Silverlake Life: The View from Here a documentary directed by Peter Friedman that follows the lives of Tom Joslin and Mark Massi as they are living with and dying from HIV/AIDS.

Reading:

• Cante, Richard C. “HIV, Multiculturalism, and Popular Narrativity in the United States: Afterthoughts on ‘Philadelphia’ (And Beyond).” Narrative, Vol. 7, No. 3 (Oct. 1999), p 239-258.
• Mathijs, Ernest. “AIDS References in the Critical Reception of David Cronenberg: ‘It May Not Be Such a Bad Disease After All’.” Cinema Journal, Vol. 42. No. 4 (Summer, 2003) p. 29-45.
• Winskell, Kate and Daniel Enger, “Young Voices Travel Far: A Case Study of Scenarios from Africa”, chapter in: Hemer, Oscar and Thomas Tufte (eds.), Media and Global Change: Rethinking Communication for Development, Buenas Aires: Clasco, 2005
• Winskell, Kate, Oby Obyerodhyambo, Rob Stephenson, “Making sense of condoms: social representations in young Africans’ HIV-related narratives from six countries,” Social Science & Medicine, 72 (2011) 953-961

 

Media and Public Perception by Meg Lacy

I found the Kalichman and Hunter article on “Magic” Johnson a fabulous analysis of the influence celebrity disclosure has on public attitudes and perception of HIV. I also thought this article provided a helpful framework for understanding the way other media, such as music, shape public perspectives on HIV and social change at large. Of all of the assignments for this week’s discussion, I found the two songs from the 80’s (“It’s Christmas Time” and “We Are The World”) the most compelling content for analysis. These songs, devised to raise money for Africa, strike me as interesting for two reasons (besides, of course, the plethora of mullets). First,
I’m interested in these pieces of media because of the way they seamlessly employ religious language and imagery as an impetus for secular social change. And second, these pieces of media “mediate” particular (and diverging) understandings of the relationship between Africa and the United States, shaping public attitudes concerning the role America/Americans play(s) in global change, similar to the way celebrity disclosure shapes public attitudes of HIV in the US. 

Religion and Media
As a theology student, I find it interesting that the lyrics of both “It’s Christmas Time” and “We Are The World” employ religious language and imagery in secular media. At the risk of stating the obvious, “It’s Christmas Time” is secular media embedded in the language of a Christian Holiday, Christmas. While many might argue that Christmas is now a secular holiday, the lyrics of this song make explicit spiritual claims. Rather than mentioning gifts and Santa, they define Christmas as a time “we let in light and we banish shade.” Prayer is also states explicitly in this song as a means to a better world. Likewise, “We Are The World,” makes two fascinating religious references. The first locates our shared humanity in our shared identity as a part of a religious family—“We’re all apart of God’s big family.” This is followed by an explicit claim on truth, “you know the truth, love is all we need.” While religion has no monopoly on love, the use of a truth claim to advocate for love seems a very religious thing to do! I find religious language and imagery in these songs interesting because of the assumed association of religion/justice/care/love. That is, for these lyricists, religion seems to be the obvious framework for compelling people to love and care for others (ie, those with AIDS in Africa). Now a quarter of a century later, I wonder if this religious language would be rendered ineffective, or even counterproductive. While secularization theory would certainly suggest that religion was on its way out the door in the 80s, it is arguable that religion had more clout in the public sphere in the 80s than now. Would the use of religion in media now be a useful tool for shaping public attitudes, or a detrimental/irrelevant one?

Media and Articulations of Social Change
While both songs share a common notion of religion as pertinent to care/social change (rather consciously or unconsciously), they diverge in their conceptions of what this change looks like. Each song envisions a different relationship between America and Africa, and each vision has the capacity to influence public perception and discourse on HIV and America’s role in foreign aid. “It’s Christmas Time” sets up a clear us/them dichotomy. Nearly every stanza makes an us/them claim. That is, “pray for the other ones” (Africans), “here’s to you [Americans], here’s to them [Africans], “thank God it’s them instead of you.” I appreciate the sentiment of this song but must take issue with its emphasis on charity rather than justice. This song sets up an us/them discourse that envisions a world in with wealthy westerners should offer charity to those less fortunate by “feeing the world,” a largely destructive and rejected conception of social change. On the other hand, “We Are The World” offers a much more mutually beneficial conception of change. The lyrics of this piece hold in tension the responsibility one has as a privileged westerner and one’s intrinsic connection to those experiencing injustice—“it’s time to lend a hand…change is gonna’ come when we stand together as one…we’re saving our own selves.” This conception of change reminds me of Dr. Martin Luther King, Jr.’s insistence that “Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality tied in a single garment of destiny. What affects one directly, affects all indirectly.”  (Letter from the Birmingham City Jail).

It is important to note these diverging conceptions of social change because they contribute to public attitudes and conceptions of change—particularly America’s role in global discourse and aid for HIV. As I consider these two diverging conceptions of change, a more recent lyrical articulation of injustice comes to mind. The Raise Hope for Congo Campaign (a sector of the Enough Project at the Center for American Progress) recently released a compilation album assembled to raise awareness concerning women and children who have experiences extreme violence in the ongoing conflict in Congo. Although this justice issue is in many ways different from that of HIV, it is similarly an international issue, which requires response and accountability from the West (and, likewise, other nations). The concept of partnership in this album strikes me—it articulates a new way of conceptualizing the role of the West in global politics and aid. Partnership can be seen merely in taking a look at the artists who contributed to the project. Among American artists such as Norah Jones, Sheryl Crow, and Damien Rice are Congolese women and men who have chosen to partner with Western artists in order to raise awareness concerning their country’s plight. Partnership is also reflected in the lyrics of many of the songs. Below I have provided some of the words for the album’s title work, “Raise Hope” (written by Omekongo Didinga & Shahin Shahida).  The idea of “partnership” may not have been possible 30 years ago, but it is now, and I am encouraged by this clear articulation of new conceptions of global change.
 
Together with the Congolese
We can change this direction
If you decide to raise your conscience
And each one teach one
Reach one in your grasp
We can make an army of change
An army of conscious consumers
Not soldiers of the same old sympathetic solution
For political and profitable prostitution
The true resolution is the empowering of our women
The center of our land must be made whole again
The backbone of our nation must be realigned
When our women can stand proudly
Our country will once again have its spine
The heart of our future
Lies in our young girls
The pride of our lives
Lies in our young boys
Congo’s future lies in our hands
If you can just understand
That we’re all in this together
So lets raise hope
And take a stand for our land

Here is a link to the album, for anyone who is interested: http://raisehopeforcongomusic.org/