Can a Laytonville Mom Prevent AIDS in Africa?

by Roanne Withers

This is the way the world ends
Not with a bang but a whimper.
                  — T.S. Eliot

From the looks of it, Laytonville, the hardscrabble Highway 101 beer and bathroom stop just north of Willits in Mendocino county, seems an unlikely home-base for a public health services expert who has tackled the world's HIV-AIDS pandemic and come up with what she over-modestly calls an HIV prevention "choice."

Raised on a Wisconsin Indian reservation, Kathleen Kempter Martin has an advanced degree in Chinese studies. In her twenties, she went with former President Nixon's first delegation into Communist China, and taught English in Beijing. Since then, the delicately feminine, 50ish mother of three teen-age and two adult daughters, has spent much of her career obtaining extensive healthcare programs and clinic facilities for the very poorest of America's indigenous communities from Pine Ridge to northern California. She also concurrently worked with eleven northern California tribal governments to procure the funds for the return of the Sinkyone, 3,900 redwood forested acres of Indian ancestral land, back into Native hands, in what became in 1995, the first Native American owned park in the US.

For nearly the last decade, Kathleen has been making her way through a plethora of FDA clinical trials, federal Research and Development grants, latex product manufacturing plants, international AIDS conferences, and through the brothels of Africa's most AIDS afflicted countries with an inexpensive female controlled HIV-AIDS protection barrier — a thin latex panty condom. She's trying to get the panty condom manufactured and distributed to women, particularly women in Africa, who are in dire need of protection from AIDS.

Recognition that the panty condom is a crucial healthcare product for women has been slow. Too slow in terms of five million new HIV infections among heterosexual men and women worldwide each year. Kathleen will explain. But first, take a moment to be brought current on the status of the AIDS pandemic and politics in the US and worldwide.

In mid-July, the head of the Aaron Diamond Foundation, Dr. David Ho (Time magazine's 1996 Man of the Year for leadership in the field of HIV-AIDS research, credited with the life extending anti-retroviral drug "cocktail"), proclaimed that AIDS is not a global crisis, it is the global crisis. He stated in his CSPAN televised speech that deaths worldwide caused by terrorist acts, wars, disease, and natural disasters combined do not come close to the total of 15,000 deaths per day caused by AIDS. He was asking for a shift in US priorities.

On his recent trip to Thailand, Secretary of State Colin Powell asked the leaders of Asian nations to view HIV-AIDS as "a security threat that could destroy nations and destabilize the region much more so than any weapon of mass destruction." More and more the multi-national corporations are finding out that their unskilled and uneducated Third World laborers are coming down with the disease. The AIDS rate is so high in some Third World nations that the ability of these countries to manufacture, to feed themselves, and to have working economies has been brought to a halt.

AIDS activists and advocates generally viewed Bush's $15 billion (over five years) funding commitment as outright fraud, and his July Africa jaunt another brutal assault in what they call his administration's "all out religious war on sexual and reproductive health programs abroad and here in the states." Congress approved only $2 billion in foreign AIDS assistance for this fiscal year, which didn't come close to restoring historic funding eliminated by the President and Congress shortly after George Bush, Jr. took the Oval Office in 2001. Attached to the current appropriation were two amendments that discourage and disparage the use of condoms in combating the transmission of HIV outside of the US. One-third of the funds are mandated to promote "sexual abstinence until marriage" in recipient countries.

On the home front, as various domestic HIV-AIDS appropriation bills came up for consideration earlier this summer, organizations and advocacy groups pleaded with Bush and Congress to restore and increase our country's AIDS research and public health program funding. 151 leading groups, including several churches, signed onto a late-June letter to the President that stated, "regressive policies of censorship and intimidation — both regulatory and informal — put American lives at risk."

Publically funded US research scientists have to stifle their public warnings or lose what little money remains of Bush's research funding cuts. Also at issue with AIDS groups is the Center for Disease Control and Prevention (CDC) clamping down on public health education and prevention programs that openly discuss sex and freely distribute condoms. According to the Bush administration's policy makers, such programs encourage pre and extra marital sex. Healthcare workers in the clinics and the schools assert that pre and/or extra marital sex are the norm for many in this country, and adult and teenage men and women need to know how to protect themselves from HIV, STDs (sexually transmitted diseases) and unplanned for pregnancies. A warning letter has been issued by the CDC threatening to withdraw federal funds if frank discussions continue.

At the CDC, our country's HIV-AIDS "prevention" program has been reconstructed to encourage HIV testing followed by counseling about condom use for those found HIV positive — only. It takes several months to years before an HIV victim becomes sick enough to discover that he or she is infected, all the while having unprotected sex and infecting others. National public health policy for preventing the contraction of the HIV infection in the first place is to "abstain from having sex outside marriage." The word "condom" has almost completely disappeared from the CDC's website. The CDC provides public health information, policy and guidance programs for this nation's schools, hospitals, clinics, public health departments, and prisons. In the US today, if your child is told about HIV and condoms in sex education class in school, this is radical and covert information, and is not the case throughout most of the nation.

At its onset in the early 1980s in the US, AIDS was declared a predominately white, but altogether gay men's disease. Then I-V drug users (mostly people of color) were included in the "population at risk" profile. Compassionate care became the appropriate reaction to those afflicted, and quarantine demands were silenced. Remedies have been found for the children who were being infected with HIV in the uterus via their AIDS afflicted mothers, and our HIV contaminated blood supply is mostly clean now. In the early 90s, the CDC minced words, but officially declared that HIV had moved into the "heterosexual reproductive population." This changed everything to do with the spread and bio-social predictable course of disease. Everything that is, except our national HIV-AIDS health policy.

The CDC didn't and doesn't come right out and say it, but AIDS scientists and professionals know that AIDS in the "heterosexual reproductive population" means that if national HIV-AIDS public health policy continues as it has under the Reagan-Bush-Clinton-Bush administrations, within the next decade or so almost no one in the US will be able to safely assume that he or she is not "at risk" for contracting HIV, if he or she engages in unprotected sex. This includes sucking and licking, no matter which color or gender the partner. Marriage is no safe haven. Half of the marriages in this country end in divorce primarily due to infidelity.

The Bush administration has refused to contribute our nation's share to the Global Fund (to Fight AIDS, Malaria, and TB), the intended-to-be international funder for integrated HIV-AIDS education and prevention programs worldwide. The Bush administration has also reactivated former President Ronald Reagan's "global gag rule" (the so-called "Mexico City policy," axed by Clinton the first day he took office) whereby US funded health clinics (including Family Planning clinics) cannot receive HIV-AIDS prevention and education funding if they engage in abortion counseling. The only time Third World women get healthcare, if they get any healthcare at all, is when they are pregnant.

In sub-Saharan Africa, where AIDS at its onset twenty years ago quickly entered the heterosexual reproductive population, the death toll is 2.5 million with 30 million more infected. India has 4.5 million people living with AIDS, China–1.2, Thailand–755,000, and Brazil–550,000. (The US is right at the top as well, with 850,000 people living with HIV-AIDS.) Most HIV-positive people in these Third World countries (those who know they have AIDS, and those who are HIV-positive but don't know it) are continuing to have unprotected sex, and these countries' blood supplies are entirely tainted with HIV ergo the infection is spreading exponentially. Since 1982, 60 million worldwide have contracted HIV, 40 million are living with the disease right now, and 20 million have died.

95 percent of the world's 5.5 million+ annual new HIV infections are in developing nations, the poorest of our global neighbors, where the annual income per person is around $500. At best, these nations' governments have the financial capacity to spend $5 per year per resident on healthcare. The current $10,000 per person per year cost of the anti-retroviral drugs can be brought down to $1 per day per person through subsidies. Still, this $1 per day is too costly for most Third World individuals. At $1 per day per HIV infected Third World person, the current estimate is that it will cost $10 billion a year to deliver all the needed anti-retroviral drugs to the Third World nations. The drugs should be made available, but the handwriting on the wall is unmistakable.

And if all of this has not completely boggled your mind, consider that other than abstinence, preventing body fluid molecule-bound HIV transmission depends solely on men wearing rubbers. There is no feminine (woman controlled) protection from HIV on the market — any market in the world — that works.

In 1996, when Kathleen Martin first showed me a rough conceptual prototype of a woman's bikini panty with a then rubber crotch and inverted tube, I saw its potential, but my strongest reaction was, "No skin-to-skin contact below the mons venus? Great for HIV positives and prostitutes, but moi? No way!"

Kathleen oh so quietly responded, "Roanne, it has come to this. AIDS has come to this for us and our daughters."

If your gut reaction is like mine — to mostly be appalled at this notion of making it all covered in latex — this is to be expected. When it comes to sexual intimacy, most experienced people's thinking tends to evaluate everything to do with it from a place of personal history and preference, and no further. I didn't get it for a long time, even though I wept with abject grief each time over the years that Kathleen returned from Africa and processed her almost unspeakable horror and despair with me at my kitchen table. Even though I took her HIV warnings seriously and made sure that my son was very familiar with condoms at a young age. Even though I agreed several years ago, when she needed some support, to serve as one of the volunteer directors on the panty condom's non-profit, Zebra Foundation. After all, I thought back then, making sure the annual non-profit reporting paperwork was in order was the very least I could do for my friend and colleague who was hell-bent on risking her life each time she went abroad to the war-torn, starving countries of Africa — thick with roaming, gun-toting bandits, Ebola, and who knows what else — no matter how strongly her friends and family tried to talk her out of it.

However, it wasn't until the AVA's editor, Bruce Anderson, got wind of what Kathleen was up to and pushed for this interview, and after I read my way through a mountain of AIDS professional resources in preparation, that I fully realized that Kathleen is correct. Surviving HIV-AIDS has indeed "come to this."

* * *

AVA: AIDS is everywhere now?

Kathleen: Everywhere in the world there is an emerging AIDS crisis. We know it's in China, it's in India, Russia. In Russia, it started with I-V drug users. In China it started through the blood supply. Now it's gotten into the heterosexual population throughout the world. The disease has taken on a life of its own. Because it is transmitted through sexual intercourse, there is almost no way to stop it. It's beginning to impact the Third World workforce.

AVA: Well, that presents a horrible irony — corporate globalization crumbles because of AIDS?

Kathleen: In the Ivory Coast, for example, the Belgium-owned plantations are sending their infected workforce off down the road and bringing in more, and then they send them off down the road. Third World countries don't have health care; AIDS is not treated. You get sick, you go home and you die. In Uganda, where there have been wars over many years, combined with AIDS well into its 20th year, the adult healthy male population doesn't exist any more in terms of productivity. Women in Uganda have always been the agriculturists and the nurses, but now they are often the sole wage earners in a family, the only wage earners in the country. They have had to take on whole new roles, not only being the backbone of Uganda's rural economy, but managing the government as well. This has never happened in the world before, and its all driven by the fact that there aren't that many people left in Uganda to manage the businesses and the family plots of land because of AIDS. This is where the rest of the Third World is headed.

AVA: AIDS entered the US heterosexual reproductive population ten years ago. Why aren't we hearing more about what this means?

Kathleen: In the US, we still have not shifted our thinking, even in San Francisco, the most AIDS aware, progressive part of this country. AIDS started in a population that was easy to ostracize and thus minimize the risk — the gays. That's what makes it so difficult getting the message out now that virtually anyone and everyone who is sexually active is at risk of contracting HIV here in the US. It's women of all ages that we need to be educating and protecting now. This country lacks a coherent view of what the problem really is and how we absolutely must adjust ourselves to the disease. In the US, the HIV-AIDS support and community education groups, that were so prevalent five years ago, have all but disappeared. If they were lucky enough to have state and federal funding in the first place, this has been cut. Almost all of this funding is gone.

In Africa, we have a pretty good idea of what the problem really is. The Ugandan government has been engaged for the last decade in a massive public awareness campaign called the "A, B, C, D" of HIV — "abstain," change "behavior," use "condoms" or "die."

AVA: You were telling me after your first trip to Africa to an AIDS conference in 1997 that the economy of Ivory Coast was in shambles. They had no way to get the crops into the stores because most everyone was sick.

Kathleen: In the Ivory Coast, the people had fish because the country is on the ocean, but they did not have refrigeration. The fish that was caught was rotting on the beaches. There wasn't the man-power to harvest, and then take that harvest to market.

Zimbabwe, once a beautiful country of artistic, energetic people, has been hit so hard by AIDS. The population hit the hardest there has been the artist community. The source of knowledge that produced all of their world renown art — the sculptures, the paintings, their metal arts, textiles — is gone. The artists have all died off. The young people don't have any of the teachers of even the common culture much less their arts. In Kenya, too. Hundreds of children show up for school, two, three, five hundred at each school, but the teachers have all died. Teachers were the first to die there. In South Africa there is hardly anybody left in the teaching profession. The teachers, the nation's educated class, are gone.

AVA: President Bush touted US economic development support for Africa in his recent trip. Will this help the situation?

Kathleen: I don't know where people in our country get the idea that what sub-Saharan Africa countries need is technology and economic development projects. The people by-and-large are too sick to work and there are virtually no hospitals. In so many places the infrastructure is totally gone — the Ivory Coast, Nigeria, Zimbabwe — they have high rises, they have modern banks, but the buildings are all empty. When these countries got their independence from whichever colonial government had finished thoroughly exploiting them, they were left with the buildings, but not the skills. Belgium, the British — they didn't train anyone. There is no skilled, trained labor force that can step into these positions. There's this vast void with no in-between.

AVA:You were shocked at the amount of displaced and sick people just sitting along the streets. And you kept saying over and over after your first trip to the Ivory Coast, "There were no old people."

Kathleen: And no old people. Most people in sub-Saharan Africa are grandparents by the time they are 35. They have three generations to our two. Most people there die before they reach 40 or 50.

AVA: Dr. Ho stated in his speech that one in five pregnant women in sub-Saharan Africa have AIDS and their surviving children will become orphans in eight years for a total of twelve million orphans a year. The sub-Saharan countries are nations of mostly parentless children now?

Kathleen: In every country we went through — South Africa, Zimbabwe, Uganda, Nigeria, Senegal, the Cote d'Ivoire, Kenya — every village and town has a huge orphanage. The orphanages are the main centers of the villages. When we talk about statistics, what we really need to do is look at what AIDS means on a village level. Most of Africa is comprised of small rural villages. It's the male heads of the households who contracted the disease first, infected their wives, and then died. The wife then goes to her husband's brother or her husband's family. Then she dies. So they take in all those children, and then these adults die. I have seen so many grandmothers taking care of 18, 20 children. All of the parent generation has died off. The other thing that you see — and this is part of the problem when you hear about anti-retroviral drug treatment being made available, besides the fact that refrigeration for the anti-retroviral drugs is mostly non-existent — no country in Africa has a clean blood supply.

AVA: Nor in China...

Kathleen: There is no such thing as an AIDS-free blood supply in most of the Third World AIDS-afflicted countries. So when you go into a hospital, say in South Africa, 50, 60, 70 percent of the people being treated for whatever other disease they have, they also have AIDS or are HIV infected. One of the things I realized after spending time there is that the healthcare workers in Africa cannot keep themselves from becoming infected. The hospitals cannot afford latex gloves for their healthcare workers.

AVA: But what about all the humanitarian efforts that we hear about?

Kathleen: Here's a good example: I went to Uganda with a group representing a medical department from a southern California university which is mandated to provide healthcare and training in developing countries. One of the purposes of the tour was to assess how to bring in tele-medicine services. Teaching and diagnosing electronically is what this university does very well. We went through days and days of meetings at the best rural hospital. The hospital director gave us this really nice presentation. She had the reports and the data, piles of paperwork. Then we went on a tour of the hospital. The first thing we were told was, "We took the beds out to be cleaned." The truth of the matter was, the hospital didn't have any beds. And the hospital probably hadn't had any beds for ten or fifteen years. They did have boxes and boxes of used medical equipment from Europe. But the hospital didn't have a telephone. It didn't even have electricity. So, here is this well intentioned, well funded group trying to set up electronic tele-medicine. They couldn't have even called this hospital on the phone from Uganda's main city, Kampala, much less from the across the world. Americans have this image — Africans are waiting for us to bring them all our technology. What good is our technology? Africans need access to basic resources more than they need us coming and solving their problems for them in a "tele-medicine" kind of way.

On the other hand, when I was sitting in an airport on my way to Ethiopia, I sat next to a South African businessman who flew back and forth from England to South Africa for his business. He casually said to me, "Look at it! You can't worry about any of these AIDS people, because they are less than one-tenth of one percent of the world's gross national product." Even though Africans represent one-fifth of the world's population, this businessman expressed an attitude that I am constantly running up against — "Don't worry about them, because what is being lost in terms of money? Nothing."

AVA: When you started out with the panty condom concept nearly a decade ago, you thought the way to get it into Africa was to produce it in the US. What made you stop working on this and go directly to Africa?

Kathleen: There are many reasons. When we were in the US and were exploring the idea for a female prevention product for a number of years, over and over again the response was: "Women don't want this; women would never use it." Or, "Women in the world, especially the Third World, are not powerful enough to have something like this — they would never be able to convince their male partners that they should be able to use this." All various levels of government and NGOs in the US were telling me "No!" The Clinton administration didn't have the political will to get a women's HIV education program going even in the US. This was why I started going to Africa. I just had to know what Africans really thought, instead of what I was being told they would think. So, I went to the Ivory Coast to the first All-Africa AIDS conference. What a difference! For the entire four days, my condom display table was deep in young people. Men and women wanting to show the panty condom to their partners, wanting samples. Wanting, wanting, wanting. I thought, "Wow!"

AVA: Why the difference in reaction to the panty condom between here and there?

Kathleen: In my mind, when people are down to the level of survival that exists in Africa, they will openly consider a number of things that people wouldn't normally choose. I started talking to women in Africa, showing them panty condoms, and then talking one-on-one, and in small groups. I went to the outdoor market places and set up a table. I found out that we here in the US, believing we are less threatened by the disease, impose our idea of what women can and cannot do from our own perspective. But the women I talked to in Africa, all said, especially in Uganda and Nigeria, "Just give it to us. If it's a woman's thing, if it's for us, then we should have it." It's one thing to negotiate with a man by saying, "You need to put this condom on." But it's a complete shift in power for women to have our condoms already on, and say "If you want me, this is how you get me." The women I met in Africa knew this immediately.

AVA: You didn't need to go into sexual politics and the feminist perspective?

Kathleen: No, never. The women I met got it right away. I went through a whole catharsis about AIDS prevention, thinking, "What do we women have to do to convince the man to wear a condom?" And it isn't that way at all. I think that women the world over know what they need, and they know what they want in terms of their own life styles and cultures. We know that we need to protect ourselves — to prevent pregnancy, to prevent STDs and AIDS. We are still asking for the same things we have been asking for for 30 years now, ever since we got The Pill. We need safe, easy to use, inexpensive contraception, and something to protect ourselves from disease. This has been a platform plank at the international women's conferences held in Cairo and Beijing.

AVA: When we first talked some years ago, you warned me about the contraceptive sponge I was using. I thought I had finally found a product that also protected me from AIDS, and I was thrilled that my partner didn't notice it. You told me that it had been discovered that the spermicide in the sponge and all other women's contraceptive products, Nonoxynol-9, irritates the delicate, capillary-lush tissue lining of women's vagina creating an open invitation for HIV to enter our blood stream. The Reality women's condom was the only other women's option on the market. Everything about the Reality is, what can I say, other than stupid?

Kathleen: This I know from experience out in the field in the US and in Africa. You can't give the Reality away to anybody. Seriously, we tried to give it to people here and in Africa. Just give it to them. Those who want something. They would take the male condom, they took everything, the lubricant — the Reality is grotesque looking. That's what women say.

AVA: Let's see if we can describe it for those who don't know what we are talking about. Reality looks like a male condom made for an elephant...

Kathleen: It's shaft shaped.

AVA: It's worn inside the vagina, and the minute the penis goes in and moves about, the Reality shifts around, balls up and slithers out!

Kathleen: That's exactly the problem. And it hurts the penis horribly because it has a ring that fits up against the woman's cervix that's suppose to hold it in place. There were several barrier products being looked at in the '90s, but Reality is the only one that made it to the market. It has a 27 percent failure rate for pregnancy. With the Reality, there was a study in Brazil, and they had to bring those people back, and back, and back again to show them how to use it properly. The sick thing about it is that no one in the Third World can afford the Reality condom. Almost no one. Maybe the upper class, maybe the upper middle class. But who in the Third World can afford $3 a piece or even a subsidized $1.50 a use?

Under the Clinton administration, the Ugandans had USAID [US Agency for International Development] trying to force them to take it. USAID said, "Reality is part of an AIDS prevention program. We'll give your country dollars to buy this women's condom." The Ugandans said, "Our women don't want it." Shortly after that, we met with them. When we showed the Ugandans the panty condom, the response was, "Oh, what you have makes sense." And they said something that I found, in this day and age, to be surprising. They said that no company, no manufacturer, no product developer has ever come to Africa and asked them what they thought about a product, and how it could be different or improved before it was manufactured for them to use.

We took the concept of very simple barrier protection and asked them if was acceptable to their people. By in large, except in a few instances, a woman using a barrier to protect herself has not been rejected in Africa like in the US. Again, we are working in a population that is trying to insure survival of their genetic pool. I'm talking about women who are opting to leave their families and villages to go into safe houses, taking the young girls — whoever they can get who is not HIV infected, and hiding them away. That is a level of survival that is... is...

AVA: ...is almost inconceivable.

Kathleen: An entire generation has been virtually wiped out. We're involved with a foundation that opened up a treatment center in South Africa. The treatment center has 50 patients. It is the only treatment center in South Africa. In Uganda, the AIDS treatment center has ten patients. Ten patients! You'd think in a population center where all these people are infected — that this must be a horrible circumstance, but to them, those ten or fifty people are the only hope of survival. Otherwise, there is no hope at all.

AVA: The AIDS plague is wiping the world's genetic diversity contribution from Africa off the face of the earth and yet very few in the US even want to talk about it, much less try to do something. Is this indifference or deliberate genocide?

Kathleen: People I talk with in the US generally feel a big distance between the AIDS problem in Africa and their daily lives. In conversation they either say or imply, "It's tragic, but these people must really start to do something for themselves." Some African American leaders in this country are discussing our country's leadership attitude as deliberate genocide. What is the basic truth? The truth is, Africa been written off by the US and the rest of the industrialized nations. But I work around the politics. Keeping focused is the key to getting the panty condom produced and into the hands of women who need and want it.

* * *

There are a thousand hacking at the branches 
of evil to one who is striking at the root.
                  — Thoreau

* * *

AVA: AIDS is about to annihilate much of Africa followed shortly by the rest of the Third World. Unchecked, the AIDS probability and trend math whizzes calculate that humanity altogether has about 50 years until doomsday. The battle plan to address the global AIDS crisis is education, prevention, treatment, and someday, hopefully there will be cure. As an AIDS public health professional, Kathleen Martin, what about the most immediately available remedy — safe-sex education and prevention in the Third World AIDS countries?

Kathleen: These countries look to the US. The problem with this is that the Bush administration is promoting abstinence as the HIV-AIDS prevention model here and abroad. Under Bush, US tax dollars are not going to be spent procuring and distributing condoms in Third World countries. Bush's policymakers have recently started saying that condoms don't work. Male condoms don't work 10 percent of the time because they are not used properly, not because they don't prevent pregnancy and the spread of HIV.

Other than in a few countries in Africa, safe-sex AIDS education and prevention is virtually non-existent in the Third World. Botswana has the worst incidence of AIDS in the world. Of every three people, two are HIV-positive. They simply don't know or believe that having sexual intercourse will infect them with the disease. Botswana recently received a huge grant from the Bill and Melinda Gates Foundation. What the Gates Foundation is doing is literally knocking on every door of every dwelling in this country. Health workers are introducing every single person to safe-sex practices, condoms and whatever else becomes available. They would distribute the panty condom in Botswana once it is available. That is what education has to mean in sub-Saharan Africa in order to change behavior enough to make a difference. The Gates' project is the most comprehensive program in sub-Saharan Africa. In Zimbabwe, we couldn't get the men to discuss sex in any way. In Nigeria, they didn't even know what the words for AIDS and condom meant. The common ideas did not exist. Whole populations in Africa have no clue that having unprotected sexual intercourse will kill them. In other parts of Africa, some men believe that having intercourse with infant girls will cure them of AIDS.

AVA: President Bush did give high praise to Uganda for its HIV-AIDS education and prevention program on his recent visit. What's going on there?

Kathleen: The Uganda government is the first African government to address AIDS. It has an HIV awareness campaign that is into its tenth year. Now, you can't talk to anyone in Uganda with out talking about AIDS. The politicians, the clergy... they all know about the disease. But when it comes to HIV prevention practice we discovered that there are some problems. We conducted discussion groups in Ugandan brothels, and with commercial sex workers on the streets in Cape Town and Durban in South Africa. We also went to some places in Nigeria. Over and over women, or really just girls, they are so very young, knew all about AIDS. They could get tested if they wanted to. Their customers were told they had to wear a condom. But the truth is, at the point of intercourse, the man always offers more money, another $10 if he can take the condom off. There's always that final negotiation.

AVA: And the woman thinks of the hungry children at home...

Kathleen: That's what HIV education really means, changing people's most basic behaviors. And what exactly does it take to affect that change? I've come to think that we really don't know whether or not women can successfully negotiate at that final moment, yet. By this I mean, can women unconditionally and absolutely deny a man sexual intercourse every single time unless he wears a condom? Right now, denying a man access to her body unless he wears a condom is all that a woman has to negotiate with — all she has to protect herself from AIDS. That is, if she understands that she is at risk in the first place.

AVA: The human capacity for ignoring consequences is pretty powerful...

Kathleen: Yes. At what point do individuals become absolutely certain that for their own safety, and the future and safety of up-coming generations, that they must protect themselves from HIV by using a barrier? Eight years ago, I was at an AIDS conference where a doctor from India stood up to explain that his peers finally understood that safe-sex HIV education wasn't about whether or not people used barrier protection, it was about which barrier protection they used. Everyone working in the AIDS field knows that barrier protection is a must. I don't care if you live in Mendocino county, or wherever. It is Russian roulette. That's why the male condom, and hopefully soon, the female panty condom — using a barrier — has to become like brushing your teeth.

AVA: We must cover our crotches in latex?

Kathleen: I've talked with so many of our generation's enlightened women in the US who are repulsed by the idea of female and male condoms. Young people don't think this way, though. They look at a pretty piece of thin latex, they say "Oh that's cute, what do you do with it?" or "Oh, cool." I haven't run across any of our generation's attitudes in young people in the US. Young people's reaction to the panty condom is the big plus side. The negative side is in my own daughters' school district — where the most recent national teen sex survey has one-fourth of the kids in this country becoming sexually active in the eighth grade — they are not being given any HIV information at all. If kids have to wait until the very moment they are about to have sexual intercourse before they talk for the first time about condoms, disease and so forth — basically where saying the word "condom" to a member of the opposite sex for the first time is difficult and embarrassing — it's too late. AIDS was the number one cause of death in the US in the 22 to 44 year old age group up until 1995 when the anti-retroviral drugs added another decade or so to the lifespan. It won't be long before AIDS will take its toll on the anti-retroviral drug users and AIDS becomes the number one cause of death in this age group again. In the US, half of the new HIV infections are in young women now. At the UN, I heard heads of governments from around the world stand up and say they knew they had to go home and start telling their people that they have to give women of all ages access to healthcare so they can learn early enough how to take care of their bodies, how to protect themselves from AIDS.

AVA: Has Bush re-activating the "global gag rule" harmed this international effort to help women know they need to protect themselves?

Kathleen: The fact is that the only time that Third World women get to the doctor, if they get any health care at all, is when they are pregnant. So, if health clinics offer any type of abortion counseling they cannot qualify for US HIV-AIDS education and prevention funds, much less any other healthcare funding. It is the US tax-dollars that keeps these health clinics open. The impact on women's global healthcare over the abortion issue is separate, but has really impacted everything to do with women's HIV education in the Third World.

AVA: All we are hearing about in the US is protection of abortion rights from the feminist women's organizations. Where are the women's groups on the AIDS threat to women?

Kathleen: That's right. There are some serious but under-funded international women's groups, more UN and European based, working on the women's AIDS problem. There are only four or five well endowed foundations in the US that focus on women's reproductive health. The only time that I have ever lost it with a potential women's AIDS education program and panty condom funder, was when I was talking with a woman who headed one of these leading corporate foundations that was very active in reproductive rights. It was highly recommended by all the other foundations. The program officer told me after I gave her my presentation, "The most important issue for women is reproductive rights — abortion. Period."

I said, "Well if you want to address abortions and the "global gag rule" what better way than to prevent pregnancy in the first place? Safe-sex education and the panty condom do that." We were turned down.

AVA: This brings us to the difficulty you are having getting the panty condom manufactured and on the market. What do you say to potential funders?

Kathleen: My message is that we must be able to offer women a protection choice. All that women have now is the male condom, which is barely used by men and doesn't work at all for women. The male condom does not cover all of the area on the woman's body that we need to protect. Bottom line, choice is where the HIV-AIDS solution is. Not treatment, not a vaccine, but prevention choice. The more products the better. Generally, women can't afford the cost of the anti-retroviral drugs. Besides, the side affects of the anti-retroviral drugs are horrendous. Many women don't want to go through several years of being so sick. They just don't want to. Many stop, and the virus mutates. The AIDS science community didn't know about the untreatable, super-virus mutation until just recently. At the very minimum, we are ten years away from starting ten years of trials on a vaccine. Twenty years! There is no cure for AIDS, and there is no treatment per se so we are really back at the starting place in the mid-80s where prevention is it. We've gone backwards in women's healthcare in the last decade.

AVA: The panty condom seems to be a simple solution to a mind crushing problem. You've told me privately that you have tried everything there is, and have come up empty handed in terms of getting this panty condom made and to the women who need and want it. Why is this?

Kathleen: Well, the panty condom itself is not a panacea. It's one tool, one choice where there aren't many choices. The panty condom concept has been tried before and has failed in terms of what other proponents thought might work in the design. It was tried in India, but the design didn't work. Attaching it to frilly, silky panties was tried, but this drove up the price to where it was cost prohibitive. This one was not practical from a Third World public health perspective. In the US, for the most part, a healthcare product cannot be designed, manufactured and distributed unless its done by a big pharmaceutical company. The main problem for the pharmaceutical company is the money. Before an internally worn healthcare product can be put on the market in the US, or made in the US and taken to other countries, it takes years of costly clinical trial testing before the Federal Drug Administration will even consider approving it.

AVA: Wait, stop right there. Why is there not money in the panty condom for Big Pharm?

Kathleen: A pharmaceutical corporation that is bringing on a new drug or healthcare product in the US has to invest, at minimum, ten years of time, money, testing, and marketing. What it wants in the end is some profit. There is no profit at the big pharmaceutical scale in the panty condom. Even reducing the $10,000 a year AIDS drugs down to a $1 a day, they are still not affordable in Africa and most other Third World countries. There will be some profit in a panty condom, but it will come from volume. But, profit per person? Nada. The huge per person profit margin the pharmaceutical corporations require before they'll invest in a product is non-existent. It costs $10 million for anyone with a new product to enter the US market and distribution sector.

AVA: And that's before I would see it on the store shelves in Fort Bragg, and before woman could obtain a US made panty condom in Africa?

Kathleen: That's right. There no small business that can do this, especially with just one product.

AVA: What about the male condom manufacturers?

Kathleen: They took one look at the poor sales performance of the Reality condom and slammed the door on the panty condom saying, "Women in the US don't want condoms. Nobody will buy it." It's the profit from the 8.5 billion male condoms made a year that are sold in the US that partially subsidize free male condoms elsewhere.

AVA: Don't these pharmaceutical corporations have humanitarian programs?

Kathleen: Some do on a limited scale, but altogether there is no profit in AIDS prevention. There are very big profits in selling HIV-AIDS-afflicted people the drugs that will prolong their lives. That's where the pharmaceutical corporate focus is.

AVA: Our government appropriates funds for all kinds of product research and development. Have you approached these agencies?

Kathleen: As far as the government agencies, there are just a few that provide funding for this kind of healthcare product development. I've been to every one of them. One guy at one of these agencies has a panty condom in his desk drawer that he pulls out, makes jokes and laughs. The very first time it was shown to men in government in Uganda in 1997, they wanted it for their country immediately. That's how disconnected these US agencies are. They are all headed by men. And if one of them is Catholic, well, forget it. Overall, except for some individuals within these agencies, the official response so far has been, "Women have barrier protection in the Reality condom, go away." But we're back to trying these agencies again. What's right is right. If we were talking about a rifle, something that harms people, I could understand the resistance, but a panty condom?

The FDA tests we have to put the panty condom through in this country... we've conducted some and have had great results, but we have more back-up clinical tests for the FDA still to do. Men have been wearing latex on their penises and inserting it into our vaginas for nearly 70 years. That's all we are talking about with the panty condom. A piece of very thin, non-allergenic medical-grade strength latex. The only difference is that instead of the same substance lining the outside of the penis, it lines the inside of the vaginal area. This takes ten years of very expensive, redundant FDA clinical trials? It's very frustrating seeing the priorities in this country. Making the panty condom is not rocket science. It doesn't even need modern technology to be made. You could make it in your backyard. And all a woman will be doing is putting on a pair of underwear, basically. Whether or not their culture has the words for it, no matter who I show it to, women all know what the purpose of the panty condom is. I don't even have to tell how them to put it on.

AVA: I've read about a chemical and plastic vaginal spray for women being worked on in Canada. Is it this type of product that is getting all the attention?

Kathleen: The interest right now is in a microbial product that we would insert into our vaginas. Can you imagine what a substance that is so toxic that it would kill HIV and other STDs being placed directly inside your body and then literally rubbed in will do to you?

AVA: I can see it now, they'll genetically re-engineer us so we have Round-Up ready vaginas!

Kathleen: That's the mind-set in Washington DC under both Clinton and Bush. The Bush administration is seriously considering funding the development of this microbial product, but it will be at least another decade before it comes on the market.

AVA: Is the corporate race for an AIDS cure overshadowing the whole prevention product potential?

Kathleen: There's a very big profit in discovering a cure — a vaccine — and in selling it to the industrialized nations, but that's not where the pharmaceuticals are right now. The big fight is on over the profits from the anti-retroviral drug patents. Do the math on 850,000 HIV-positive people in the US alone at $10,000 per person per year. It's very telling that Bush's new AIDS tsar, Randal Tobias, is the retired CEO of Eli Lilly. There are companies making the less expensive generic AIDS drugs, but the patents and the profits to be made from these patents is where the big money is. I don't think these anti-retroviral drugs are going to do much good in most Third World countries. These countries don't have basic healthcare delivery systems. It's the lack of access to resources and lack of basic know-how in the Third World that is the problem. It's transfer of know-how that needs to happen.

AVA: What do you mean by this?

Kathleen: I keep referring to Uganda, because there I saw the fundamental components and the government will to tackle the AIDS problem more than anywhere else in sub-Saharan Africa. If Uganda succeeds, the other countries will have a practical model. But Uganda needs help in getting this model together. For example, we were in the most heavily hit AIDS district in Uganda. Then we went into the district that was most heavily damaged by their civil war. Totally ravaged. We were exhausted, but our guides said we had to go to see this new university. This, after we had gone to hospitals that didn't have windows or beds, and served one meal of gruel a day. And nobody in my group wanted to go to this district because it's right next to the one that has Ebola. But we went anyway, because it seemed so very important to our guides. The university was out in the middle of nowhere. Twenty acres of buildings, dormitories, lunch rooms, libraries, everything one could want by way of buildings, teachers, and students. The students and the townspeople had built it all. They built this beautiful place all themselves with no outside funding. But they did not have one book, not a pencil, not a piece of paper. They know that in order to progress they need education, but they did not have the models and materials from which to build the presses to produce their own books, the know-how to make their own paper. If these countries are going to tackle AIDS on a scale that will make a difference, some fundamental support is needed. Delivery of truckloads of anti-retroviral drugs or even condoms isn't the answer.

AVA: In Dark Star Safari, travel writer Paul Theroux rails over and over about all the wasted humanitarian aide and dysfunctional but well-financed helping groups from the US and Europe driving around in Land Rovers. He said he saw this everywhere on his recent trek from one end of rural Africa to the other. He concluded that all that these last decades of massive humanitarian aid have done is to create an entire continent of Africans who are just sitting and waiting to be rescued.

Kathleen: His book is a good read to get a feel of what it's like in rural Africa, but I strongly disagree with his conclusion that Africans are all waiting to be rescued. I didn't get that impression at all. It's true that there are a lot of people just sitting. Acres and acres of people who have absolutely nothing, and so they sit and wait. But at the university town I just spoke of, and at many of the orphanages I visited, there were all kinds of self-initiated projects. At one orphanage, the children had come together all on their own to live communally and help each other. Six months later when I went back, they had built a big dining room by making their own bricks. They plant their food, and make their own meals. Little kids — all by themselves! Africans are not sitting waiting for charity. They want whatever we will give them, but they are not just passively waiting like Theroux says.

I have this ability to get on a plane and drop down into Kampala and meet with a group of women. It's like nothing I have ever seen. Like today, you and I had lunch and visited before we got down to this interview. In Kampala, the second you sit down with these women, you are talking gender issues, HIV, and how to move the people from here to there where there is more food, or it is safer. That's all they have time for. I found there was such a cogent level of serious discussion, work and commitment. The AIDS crisis is so serious.

AVA: So Big Pharm making the panty condom for Africa is out. The US government is out. What about an international funder for making the panty condom outside the US?

Kathleen: The Global Fund was the entity that various world governments set up to pool their money to address AIDS on a global scale. It took four or five years for us to get in line for the Global Fund money. Just as we were approaching our last hurdle, the US withdrew most of its funding a couple of years ago saying it wanted to fund AIDS projects in various countries directly. Many other countries followed the US lead, and the Global Fund was left almost high and dry after only one or two funding rounds. It was to be the international funder for HIV-AIDS education and prevention projects such as the panty condom.

AVA: Despite all of this, just before 9/11 you had things in place to transfer the panty condom manufacturing know-how to the Ugandans. What happened?

Kathleen: At the beginning of September we had just been awarded our first large foundation grant. This wasn't all we needed, but it was a key piece. We thought we were on our way. By October 1st, the funder called us to tell us, Sorry — it had to withdraw because it had lost its funding portfolio in the ensuing 9/11 stock market crash. It wasn't just this funder that lost its cash, there were many, many others including individual donors that were hit.

AVA: What now?

Kathleen: Those with venture capital want a profit and a quick return on their investment, so, that's out. Now, it's friends, and friends of friends.

AVA: That's how you started with the panty condom. It's a laborious way to raise funds, especially considering that Zebra Foundation is essentially just you and a handful of experts from around the US that you have brought together — a woman physician, an African-American Harvard MBA, latex manufactures — but all volunteer advisors.

Kathleen: It is a time-consuming way to raise funds. You know though, what got us started and what has kept us going all along has been the $5,000 here, and the $3,000 there. I support my girls by writing grants for other people's projects. As long as I can keep my credit card paid down, I have the gas money to get myself to the next potential resource, the stamps to mail a letter, my team to Washington, DC — then I keep going. You, yourself, know exactly how it is.

AVA: Yes, I do. I know that this kind of scratching for funding and limping along is absolutely grueling. You miss opportunities. Most people do not have the stamina to stay with a project under these conditions. How do you keep going?

Kathleen: You've asked me that a number times over the years. I think of my children and their safety. I can't dwell on the desperation I sometimes feel about when do we women have our victory? I think about women still not being able to have access to simple things to keep their health.

When I went to Africa the first time, to the Ivory Coast, it was there that I met this one woman who came from one of the rural provinces in one of the other sub-Saharan countries. There I was with my one and only sample and she wanted it. I had to say, "Sorry, no you can't have it." I was so taken aback when she started screaming at me, "How dare you come here with a sample and show us something like this and not provide it!" She was so angry. I think about her and what she said all the time. You know, I saw her again on one of my other trips a few years later. She was standing at the back of the crowd, looking right in my eye and waving her fist at me. Africans believe that we Americans can solve anything. That we have the money, the know-how, the resources, the time — that we have it all. And if we can't solve this AIDS thing, then... It's bewildering to them that we have all these resources, that we have so much and we aren't using it to solve this.

AVA: You are a pro at grant writing. By far, the best in northern California. You are the one experienced people go to when they need help in getting a big project off the ground. Despite the stock market crash, the really big funders, like the Gates Foundation, are funding projects.

Kathleen: I've been raising funds for humanitarian healthcare projects for almost 30 years now. It didn't used to be this way, but there's something very amiss in the US, and this is not just my perception. The churches, small businesses, and non-profits are all being stymied by the same problem. A project, no matter how important, feasible and well planned it is, absolutely will not be acknowledged or supported at the $1 to $5 million funding level unless it has achieved the smaller $250,000 funding level all by itself beforehand, or unless it has an Eli Lilly or a Hewlett-Packard behind it.

AVA: But you can't achieve the smaller funder vetting credibility because these traditional smaller funders lost their cash in the stock market crash?

Kathleen: That's it. If I could tell you how many entities that have big bucks that are waiting for us to prove to them we can attract $250,000 or a corporate sponsor. We keep moving incrementally forward on $5,000 here and $10,000 there, but if we could show that we had this sum in our coffers, or a corporate sponsor, the multi-million dollar funding doors would be thrown wide open for the panty condom. But we have to come up with one or the other. We have to. I have approached it from every possible angle. We were even awarded a federal Small Business Innovative Research grant and this didn't help with the credibility threshold. Everyone told us we wouldn't get this grant, that it's just too difficult to achieve. It's highly competitive and you have to have a research facility in place. We got it, and it was very big wow. But this didn't even get us to the curb, much less in the front door of the big funders.

AVA: Let's say this interview opens discussion with one large or several small funding donors that survived the stock crash, and they plug in, then the really big funder comes on board, and the panty condom project is funded. What would you do with the money?

Kathleen: The Zebra Foundation isn't going to be making panty condoms. I do know how to make them though. I could go anywhere in the world and make these condoms myself. I could build the factory. I know it all. But that's not Zebra's purpose. Our purpose is to get the know-how out as quickly and to as many people as possible. Then we would license it to regional areas in the Third World. The countries themselves would manufacture the panty condom. The Ugandan government has already signed on. They have a non-profit, a business advisor, and they have us. We would put togther samples of the panty condom at the latex factory we are working with here in the US, and take these to Uganda to conduct a round of testing trials with them so they take ownership of the project right away. That will be their self-generated clinical proof of the effectiveness of the panty condom for their population. Then we would sell them the know-how technology, and part of my team will train them to make the panty condom themselves. The panty condoms could be manufactured out of a vat of latex in somebody's village backyard, like India makes male condoms, or it could be totally mechanized and centralized. The technology is so simple. It can be labor intensive or fully mechanized. We can go whichever way the Ugandans decide works best for them. There are world standards for the manufacturing of male condoms, the testing, the lubricant, the packaging, the shelf-life — the panty condom would fit right into this.

AVA: The government that starts the manufacturing ball rolling then subsidizes...

Kathleen: ...their own manufacturing for their own population. Uganda could manufacture the panty condom for all the countries in sub-Sahara. We have no idea what the scale or the volume will be yet. The key will be to keep the price down. It won't work if people can't afford it. Our challenge is to keep the panty condom at least as affordable as a male condom. The World Health Organization, for example, would say, Why should we buy a female condom from Uganda for $2 for distribution in South Africa, when we can acquire the male condom for 30¢? We have to keep the price down, but if it's cheapened up too much it isn't as attractive to women. Women do want to feel pretty.

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End Note: Despite its length, this two-part interview has barely touched on all that Kathleen has accomplished, her team of experts, her experience, much less the trust and working relationships she has developed with the Ugandan government and other Third World entities. A deep, heartfelt thank you to the AVA for giving us such generous space. Since Zebra's inception, it has been this type of understanding and generosity from family and friends, and the friends of friends who have helped Kathleen bring the panty condom this far. Please join us in bringing the panty condom to life. An interested donor or reporter can reach Kathleen through Zebra's website, www.zebrafoundation.org, or at 707-984-7404, kmartin@zebrafoundation.org, P.O. Box 1179, Laytonville, CA 95454.