The Los Angeles Times from Los Angeles, California • Page 25

By Douglas Foster APE TOWN, South Africa The doctor beckons theyoung couple into his examining room, giving them just enough time to settle into their chairs but not enough to fuel their apprehension. a gray winter day at Red Cross Hospital. Rain pelts the windows in a staccato assault. The sign in the corridor outside, next to an overheated waiting room stuffed with people, reads: and Respiratory nothing save the size of the crowd to indicate that most of the children and adults are being treated for Dr. Ashraf Grimwood stands in the examining room doorway, agenial, gentle physician of the sort you might hope to have at your side when you find out whether you have HIV.

As the chief doctor for a nonprofit organization, Absolute Return for Kids, been at the forefront of the campaign to test and treat the estimated 5million South Africans infected with the virus that causes AIDS. This married pair, who left their 3-year-old daughter in the waiting room with a friend, join alarge number of couples with young children being tested on this day.They are part of a recent surge of people submitting to voluntary HIV tests. Such pillar of any effective strategy against AIDS, is spurred by the long-delayed decision of President Thabo Mbe- government to provide anti- retroviral medication in publicly funded clinics. This small scene in one hospital examining room is a welcome update to South AIDS story. Now, at last, acompelling reason to take the test: treatment available, even if you afford to pay for it.

easy if no treatment available to get overwhelmed and to think, all HIV-positive and all dying anyway, so throw away the condoms. Just give in to this Grimwood says. Maybe, he muses, part of the reason whyso many Americans and Europeans have lost interest in the AIDS pandemic scale seems so daunting, the location so distant and rarely good news. But testing is only the first step.Next comes acritical part of the effort to extend access to HIV treatment: personal encounters with patients in health centers, clinics and hospitals like this one. It is at this stage when counselors, nurses and doctors are sometimes thrown the biggest curve.

For unlike diagnoses of other major illnesses, test results for HIV threaten to reveal most intimate secrets. Looking quickly through his charts, Grimwood reels back a bit from the pages, an almost imperceptible jolt. He turns to the wife first. a well-dressed, big-boned woman with her hair in tidy cornrows beneath a blue knit cap. your test came back he says quietly.

The news lands like a blow. Her cheeks pillow. She worries her lower lip, turning in her chair to face the wall. The doctor pivots toward her husband. The large, clean-cut man in the parka reaches a hand out toward his wife, pushing his spine into the back of his chair as if bracing for more bad news.

Grimwood says, alittle louder now. test came back The large shoulders slump. His forehead scrunches in a series of ripples. these things can he asks, bewildered. The doctor nods his head, explaining that HIV often reproduces in the blood for many years before any symptoms appear.

Theirs is an example of what the doctor calls where one partner tests positive and the other negative. Most often, the doctor knows, the husband who brings HIV home to his wife. Either way, revelation of the test results can cause breakups, or worse. Grimwood adds quietly, as if trying to take some of the sting away: could have gotten infected many years before you got Jocelyne meet her gaze. Grimwood turns his hands up and opens his arms, as if he might embrace her.

He adds swiftly, talking into the storm gathering in countenance, that every day he counsels couples just like them. The doctor hopes that this couple will stay together, of course, for themselves and for their daughter. But he also intends to inspire far more frankness between them about sex and the medical consequences of their individual histories. Such frankness is often the missing link in campaigns to stem the spread of HIV. More openness, in families and among friends, could spur prevention efforts.

you using condoms when you have the doctor asks, as cool as if commenting on the weather. Neither of them answer. you having head bobs. They glance at each other. it protected Delphine shakes his head dolefully.

The doctor says a bit sternly: have to use condoms now, every time, to protect yourself from getting the virus the nub of the challenge: changing behavior without robbing people of their dignity. The moralistic approach of outsiders, particularly the emphasis on sexual abstinence in the Bush global AIDS program, hold much relevance for adults with children, especially in a country where one in four pregnant women who seek prenatal treatment at government health clinics has already tested positive for HIV. Grimwood outlines what comes next. sending Jocelyne for an additional blood test to see how her immune system is holding up, and he asks Delphine to come back for her next appointment. If her CD4 count, which measures the number of immune cells in her body, falls below 200, he explains, be eligible for anti- retroviral treatment.

When the time comes, he adds, introduce her to the medication that she will probably need to take for the rest of her life. In the hallway, the doctor sees them off. He weaves through the throng, providing commentary on the Lazarus stories around us. Women who were on their deathbeds months ago, men who could no longer walk until treatment began, children recently down to their last T-cells, bustle through the corridors. kid Grimwood says, pointing at a chubby 5-year-old boy who just months ago was bone thin and listless, what keeps me The new treatment program has spread in a spotty way across the country (the rollout has effectively started in only two of nine provinces), and only an estimated 10,000 of the hundreds of thousands suffering the late stages of AIDS have been reached so far.

Although the effort relies too heavily on a circle of overworked nurses, patient advocates, doctors and unpaid volunteers, it is the sole hope for anewly diagnosed woman like Jocelyne and for the husband and child who rely on her. Aseries of sobering, open questions keep doctors such as Grimwood awake at night. Can the rollout of anti-retro- virals be sustained? Will the program be scaled up to reach more of those who need it? How many of those who start treatment will stick faithfully to a strict drug regimen? (If they the virus in their blood will develop resistance to the medication.) But the alternative is devastatingly clear: More than 1.5million South Africans have already died of the disease. trying to do is keep the parents alive long enough to raise their own Grimwood says softly, citing the nearly 2million children already orphaned by AIDS. He calls down the hallway for his next patient.

late criminally in distributing medications widely available in much of the rest of the world, he adds. still got a whisper of a chance to beat the Douglas Foster is an associate professor at the Medill School of Journalism at Northwestern University. PUBLIC HEALTH Unveiling Intimate Secrets in South Africa Francine Orr Los Angeles Times FOUNDER: Aman and his son look at a statue of Nelson Mandela in Johannesburg. The country has made much progress in the 10 years since the end of apartheid, but AIDS has been devastating. HIV testing is vital to South Africa, but shaking families By Mitchell Koss ast month, leading investigative magistrate testified that there were 100 Al Qaeda cells in Morocco which at its closest to Spain is a mere seven miles away, across the neck of the Mediterranean ready to cross over into Europe.

The warning came in the aftermath of the March train bombings in Madrid that killed 190 and wounded more than 1,500 people. Part of the way that these cells were able to finance themselves, the magistrate noted, was through drug trafficking, an ominous nexus of terrorism and organized crime. Having just toured both nations, say important to realize that the organized crime spring up to support the terrorism, but that the connection seems embedded in much larger forces at work in places where the developing and developed worlds touch. According to the United Nations, Morocco is the largest exporter of marijuana. Though illegal, the drug is grown in the Rif Mountains, in the northeast, a region where the hold has traditionally been tenuous.

The U.N.’s Office onDrugs and Crime, or UNODC, which is conducting its second survey of Moroccan cannabis production, estimates that 1million people in the Rif are engaged in the cultivation of cannabis. Transformed into 3,000 metric tons of hashish and exported across the Mediterranean, the crop generates an estimated $12bil- lion to smugglers and European drug dealers and, potentially, terrorists. Earlier this month, I traveled with UNODC surveyors in Morocco. We visited a farmer wearing a New York Yankees baseball hat who demonstrated how to make hashish. He got out a shallow metal bowl about three feet across, covered the top with ablack cloth, put some marijuana plants on top of the cloth, covered the whole in a plastic garbage bag, and then beat the bag with a stick.

After a few minutes, he stopped to show us that afew tablespoons of pollen, a fine powder, had passed through the cloth into the bowl He told us that in a good year, his family of 12 clears about $10,000 on hashish. Other ventures, such as cattle and corn, worked out as well for them. Farther on, in an area where the forest had newly been cut back to plant cannabis, another farmer invited us into his home. He showed us a newly produced kilo of hashish, a small brown loaf reminiscent of gingerbread, one of four that his family of 14 produces in a year and sells at $1,000 apiece. His 17-year-old son plans to finish school, then join the family cannabis business.

The relative success of farmers like these encourages more cultivation. According to the UNODC, that puts last remaining forests in danger. And it also creates criminal networks to get the product of all these small farmers to market in Europe. Each year, the U.N. says, cannabis production seems to become more organized.

One day, we drove for a couple of hours on a dirt track along aridge line, jolting past the ruins of a French Foreign Legion outpost, to a spot where we could look out over a broad valley where fields of marijuana stretched for miles. might be looking at the largest industrial marijuana field in the aU.N. escort said. they will not be happy to see Cautiously, we descended to the edge of the field, close enough to see irrigation systems, tractors and plenty of migrant workers, all the staples of American-style agribusiness. Except for the type of crop, it looked a lot like Central Valley.

But what goes on in the remote Rif makes sense onlywhen viewed against the rest of Morocco and its relation to Spain. U.S. State Department per- sonnel call Morocco a Arab and a ally in the war on In big cities, like Casablanca, you can see the progressive part. A sizable percentage of women wear headscarves. And at Channel 2 television station, I saw the pre-taping of an episode of answer to One of the contestants sang Another sang York, New In the Sidi Moumen slum, where three of the suicide bombers in the May 2003 Casablanca attacks lived in three side-by-side houses, the young people insisted that they were against terrorism.

neighborhood has produced a lot of teachers and doctors as well as those three said one young man. In Tangier, another piece of the picture. In the Beni Mekada slum, where one of the Madrid train bombers was raised, groups of young men spoke of a single ambition: to cross the Straits of Gibraltar illegally to Spain. Some of the young men told of how a friend of theirs had died the previous week trying to cross an estimated 500 would-be immigrants ayear drown trying to get to Spain but that altered their intention to go. love one of the young men said.

here, you earn a living. We want to go to Spain to blow things up. We want to go because we can earn money In colorful Casbah area, a group of young men stood overlooking the ferry docks, casing the large trucks lining up to make the crossing. Those without money to pay human traffickers commonly try to hide under these trucks a generally safer method than crossing in a rickety boat, but one that makes being caught more likely. One of the young men had already been picked up in the Spanish port of Algeciras and sent back, but he was determined to try again.

nothing for us to do he said. Once they get to Spain, Moroccan men always find the easy pickings they imagined. In a park outside largest mosque, I talked to a group of young men hoping to be hired as day laborers. One, whose family had paid $7,000 for a fake passport that allowed him to come, said that if he worked a few days a month he was lucky. Some immigrants, he told us, survived by selling drugs.

Atiny number of the illegal immigrants turn, as the Madrid train bombers did, to radical Islam and terrorism, which they can finance themselves with their hottest crop. And so the deadly chain is completed. If this all sounds familiar terrorists with an agenda, the production of drugs that are smuggled out to wealthier coun- tries, the drug money used in some cases to finance terrorism about Colombia. In the 1990s, when the downside of globalization seemed more abstract to the average American, U.S. officials used to say things like, the world globalizes, crime globalizes Then-Secretary of State Warren Christopher used to speak of that is, those problems such as drug smuggling, human trafficking and terrorism that transcended borders and could be solved onlywith cooperation among nations.

Back then, the main example of these problems was the flow of drugs from Colombia, where they were produced in part by narco-guerrillas such as the FARC, through Mexico, where they became intertwined with human-trafficking networks, which in turn exist because of the migration that happens when a poorer nation exists next to a wealthier one. Today, the problem has spread. And as Morocco, Europe and the U.S. consider the challenges in the aftermath of the Madrid bombings, they should keep in mind that not looking at the first nor probably the last region to face this issue. Mitchell Koss is a television news and documentary producer in Los Angeles.

His work has appeared on PBS, ABC, MTV, CNN and NBC. He reported this story with Laura Ling. TERRORISM Crime-Terror Nexus Page4 WORLD REPORT A Special Section Produced in Cooperation with TheKoreaTimes OPINION.