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November 22, 2000
Vol. 30, No.9

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OSU writer researches fight against AIDS in Africa

Editor's note: Darrell E. Ward, senior medical writer in the Office of University Relations at Ohio State, is in Africa on a six-month Fulbright grant. He is spending two months in each of three countries, Botswana, Swaziland and Zimbabwe, conducting research for a book about how southern Africa is confronting its AIDS epidemic. He has contributed this first-person account of one part of his journey.

By Darrell E. Ward

It was Thursday, Nov. 2; my last full day in Swaziland, and I was hurrying along a busy sidewalk when I suddenly found myself looking into the face of Bhekumusa Dlamini, and he into mine. We were simultaneously surprised and pleased by this unexpected meeting.

We exchanged greetings and a warm handshake. I was leaving for Zimbabwe the next day, I told him, and we talked briefly of something trivial. Then he paused, looked into my eyes, and said, "Is there any way for a person to stay HIV positive?" That is, was there a way for someone infected with HIV to prevent the onset of AIDS.

We sat on a nearby concrete ledge along the busy sidewalk.

Bhekumusa Dlamini personifies the struggle against AIDS in southern Africa.

At 35, Bhekumusa was a touch overweight, and it showed in his oval face. He was energetic, upbeat, and people greeted him constantly as he walked through town in his anti-AIDS T-shirt. He personifies the struggle against AIDS in southern Africa.

Swaziland, a New Jersey-sized country with less than a million people, is embedded in South Africa, its eastern border abutting Mozambique. It has one of the highest HIV prevalence rates in the world: One-fourth of the population is thought to be infected; among pregnant women, 31.6 percent tested HIV positive during a 1998 hospital survey.

I'd met Bhekumusa during my second day working with The AIDS Information and Support Centre (TASC), a nonprofit organization based in Manzini that brought AIDS education, condoms and HIV counseling and testing to the rural areas where more than 70 percent of Swazis live. Most survive by subsistence farming.

Bhekumusa was also a rural dweller. He lived a dozen miles or more east of the city, in the chiefdom of Ngwazini. He was active in his community, a member of an advisory council that worked closely with the four or five elders who advised the chief.

He was worried about his community. "The people there are dying; they are dying," he told me. A year ago, he'd invited TASC to educate his community about HIV and AIDS. He'd started an anti-AIDS club to promote HIV prevention. He hoped that my work would somehow help them. So did I.

One day, I met him in Ngwazini for a closer look. I talked with a village elder; a man with AIDS who feared to tell his neighbors; a couple who'd lost a son, daughter and grandchild -- to what, they weren't sure. Maybe the epidemic.

Bhekumusa knew I was a medical writer from the United States there to write about Africans who were fighting the HIV epidemic. We'd become friends, and he asked me questions about AIDS each time we met. For example, can an HIV-positive person stay AIDS-free by taking certain nutritional supplements. Expensive ones. From America.

"Not to my knowledge," I told him. A nutritious diet is more important. A person with limited money is better off spending it on healthy food rather than nutritional supplements. "I see what you're saying," he said.

Here again was the same sad question. And all I had was the same sad answer: The best the person can do is follow a nutritious diet, exercise, live a healthy lifestyle, go to the clinic if you become ill and have a positive mental attitude.

I nearly choked on the last one, feeling a hypocrite. There are, I said, anti-AIDS drugs that forestall progression to AIDS, that do extend life. But, I quickly added, they are expensive, have serious side effects, are difficult to take as scheduled, and HIV can become resistant to them. "They are not the solution to the problem," I solemnly pronounce, as if to say: "See how lucky you are not to have them?"

"How long can a person remain positive?" he asked in the same quiet, serious tone. This is no time for a lecture explaining that once HIV positive, always positive, even after developing AIDS. He wanted to know how long a person infected with HIV can live before developing AIDS. Ten years, on average, I say, with some people living longer. Doctors can do blood counts of certain immune cells, CD4 cells, and this indicates the health of the person's immune system, I said. Such testing is being done in the AIDS clinic at the government hospital in Mbabane, the capital city about 15 miles north.

He's quiet for a moment, and I wonder: Is he asking these questions for someone else or for himself? I want to answer him frankly and truthfully, but I also want to encourage hope and "a positive mental attitude."

"That man there, I think he's got it," he said, nodding toward a tall, frail-looking man slowly crossing the intersection. "I think you're right," I said.

"Can a positive woman prevent her unborn baby from being infected?" He asks each question in the same quiet, serious way. I tell him how AZT, or even better, the drug nevirapine, can greatly lower the risk of infection. I encourage him to talk to a doctor about it, though doctors are difficult to see. Swaziland has no program to provide these drugs to pregnant women, but I'd heard of doctors giving them at their own expense.

He renewed his plea to help his community. "People are dying," he said again, shaking his head. I asked if those who are positive get together to talk. "Some do, but most are hiding; they are afraid." I encourage him to organize a support group, and that they undertake a project, perhaps a garden. They could then accomplish something positive, something that would help them remain healthy and give some sense of control over their lives, help them maintain that positive attitude.

That might be possible, he said. He was learning to use a friend's home computer. He promised to send me e-mails so we can stay in touch. That would be wonderful, I said. We exchanged good wishes and another warm handshake, and then we parted.

I looked over my shoulder and watched his white T-shirt merge into the crowd of pedestrians. The last I saw of him was the message on the back of that shirt, printed in bright red: "Fight AIDS Positively." The following day, I left for Zimbabwe.

Note: Ward says the goal of his project is to "show Americans that Africans are, in fact, struggling to cope with the epidemic. The ultimate goal is to attract more outside help to southern Africa to fight the epidemic." The project runs through Dec. 31.



Academic, Diversity plans

By Kevin Fitzsimons

President Kirwan and other administrators discussed University plans with department chairs at the Faculty Club Nov. 9.

Kirwan outlines resource options

By Emily Caldwell

Refinement of the Academic Plan is continuing despite its release to the Ohio State community this autumn, President William E. Kirwan told a group of about 50 academic department chairs and directors during a meeting at the Faculty Club Nov. 9.

"It has been described as a blueprint. I think of it as a conceptual rendering of what we want to build," he said. "Now, we need the detailed construction drawings. We're working on those now.

"The success of this plan will depend more on you than any other category of University community members," Kirwan added. "The plan speaks primarily to building the quality of faculty and developing a rich educational environment. Success in these areas is more in the hands of department chairs and directors than any other group. But this is a partnership. You're going to need help and clarity on how to respond to the initiatives called for in the plan."

He reminded chairs of the plan's overarching initiatives: build a world-class faculty; develop academic programs that define Ohio State as the nation's leading public land-grant university; improve the quality of the teaching and learning environment; enhance and better serve the student body; create a more diverse University community; and help build Ohio's future.

"This document does better than most planning documents I've seen in attempting to give realistic estimates of resources available and aligning those resources with the plan's initiatives," he said.

In response to questions about the availability of resources, Kirwan noted the four primary revenue sources Ohio State is counting on: greater state support; continued, but more focused, success in fund raising; relief from the 6 percent tuition cap; and increased federal research funding.

"I have varying degrees of confidence in the success we'll have with each of these categories," he said, adding he is most confident about the University's fund-raising ability.

Kirwan said he has some optimism about the likelihood that Ohio State will be excluded from any renewal of a tuition cap for the state's public institutions. He said support from the Ohio Board of Regents and other university presidents in Ohio is helpful, but added that Ohio State continues to convey its message to the public about how it would use such tuition revenues.

"What we are looking at is between $150 and $180 per year above the cap for five to six years. That would raise tuition about $800 -- and our tuition would still be third or fourth in the state. Need-based aid would be protected, and all of this money would go to undergraduate education," Kirwan said.

Specifically, additional revenue generated by higher tuition will be focused on such student needs as improved academic advising, lowering the student/faculty ratio and sharply increasing the quality of classroom technology. Ohio State's tuition is currently in the lower half of tuition rates among public universities in the state.

Ohio State is fairly secure in its expectations for revenues from the state of Ohio tobacco settlement, which will support research, Kirwan said. Ohio State expects to receive $35 million to $45 million (25-30 percent) of the statewide share of $150 million to be distributed over the next five years for biomedical research and technology.

"Where we have the greatest challenge is getting the state to better support higher education," he said. "This is a moment of truth for Ohio. Will it step forward and make higher education the priority that so many other states have?"

He said three things currently stand in the way of a boost to higher education funding: Ohio's struggle to find a school funding solution; declining state revenue estimates; and Ohio's deficit in Medicaid payments. "The good news," he said, "is that there is a recognition in our state, among private-sector and public officials, that we need to do something to better support higher education and move Ohio into a more knowledge-based economy."

During discussion of the proposed University calendar shift from quarters to semesters, a few chairs at the meeting suggested the administration should take a "Just do it" approach. However, Kirwan said such a move would be out of character for his administrative style. "It's always important to consult," he said. "It's appropriate for University Senate to study this so we have information before us when we make a decision. My expectation is that we will make a decision this spring."

The Academic Plan is available on the Web at: www.osu.edu/academicplan/.



Creative approach to proposals encouraged

By Emily Caldwell

Ohio State administrators are encouraging deans and department chairs to be creative and thoughtful in planning ways to enhance the climate for women and ethnic minorities in academic units.

"There is no cookie-cutter recipe for what individual departments can do to promote diversity and a genuine sense of community on campus," Executive Vice President and Provost Edward J. Ray told about 50 department chairs and directors during a meeting at the Faculty Club Nov. 9. "I believe that it is reasonable to expect you to determine what you can do in your area to help to advance the University's efforts. You should let us know how the central administration can be helpful in supporting your local efforts."

Ray was discussing an element of the Diversity Action Plan, which requires leaders of academic and vice presidential units to undertake a diversity project from the plan; administrators and units will be held accountable for implementing their plans and contributing to the University's progress toward its diversity goals.

"We know there are genuine problems in a number of areas with regard to available pools of job candidates; in some units, there are no faculty openings this year, so there may not be immediate opportunities to change the faculty profile," Ray said. "There are still issues to be addressed and actions that can be taken. Colleagues can get involved in Columbus schools, encouraging young people in areas like physics, or math, or economics -- disciplines they may not know about and could consider for careers. You could sponsor lectures and seminars that address diversity issues in your disciplines. Departments could enlist the help of others, such as the Office of Faculty and TA Development, to help to assess class climate and develop approaches that would make the learning environment more inclusive. Explore whether or not there are opportunities within the curriculum to address diversity issues.

"We are a very heterogeneous group. Knowing what you can accomplish means first knowing the constraints that exist within your area. You and your colleagues are in the best position to determine how your program can best contribute in the short-run and the long-run to helping the University to become more diverse and welcoming."

Mac Stewart, interim vice provost for minority affairs, also addressed the group, urging his colleagues to consider him and his office a resource as the University community seeks to make progress toward its diversity goals.

During a question-and-answer session on the plan, a number of chairs raised the issue of international faculty contributing to a department's diversity profile. Among the plan's goals is a call for deans and department chairs to increase the representation of women and minority faculty in their disciplines.

"We are not interested in anything like setting hard figures for hiring, but it is hard to monitor our success in improving our diversity profile if we do not set goals," Ray said. "If everybody casts a net as broadly as possible, and makes the environment welcoming to women and minorities, our goals will be met. Obviously, if we have colleagues from all over the world with different cultural, political, educational and religious experiences, and they are made to feel that they are a genuine and valued part of the fabric of this community, then we will all be richer for it."

Ray noted that the Diversity Action Plan committee, in determining goals for increased representation of women and ethnic minorities among faculty, did so with Ohio State's demographics in mind. He said that overall, the plan calls for "seeing movement in the right direction -- more, not less."

Ray said Ohio State has had success in hiring faculty with diverse backgrounds, but isn't always successful at keeping them here. He said the climate issue is very real for faculty, staff and students.

"I want you to ask yourselves, 'What can I do differently that might help improve the climate, and might help us nurture and retain more women and minority students, staff and faculty and convince women and minorities that they can not only stick it out here but actually prosper?'" he said. "There are so many dimensions to diversity, and so many different directions you can take. And this climate business is real. It is not just about the numbers. It is also about what this place is like to live, learn and work in for women, minorities and others who feel marginalized and undervalued."

The plan is available on the Web at www.osu.edu/diversityplan/.





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