This posting is being written over a long weekend in Canada. It will only be posted on the website in early July. The reason is that I am one of the contributing authors to a paper being published in the journal Health Affairs and the article was released on Monday. That means we could put a link up, but not until 4 PM Eastern time on 1st July. Eastern time refers, of course, to the time in New York and Washington, not Moscow. The writing was led by Steven Forsythe, someone I have known for many years, and who did his Ph.D. at the Liverpool School of Tropical Medicine. Apart from him there are another seven named co-authors. The title is Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits. It will go on the reading list for my students.

The other activity I have been extensively engaged in over the past couple of weeks is editing The African Journal of AIDS Research. I am the Editor-in-Chief. This means that I read every article that gets through the review process to approve it for publication. We are now getting about 260 articles submitted every year, we only publish 40 (and these I read), and so there is quite a lot of work involved. On the other hand it is does give me a forum to express views in editorials, should I wish, and keeps me up to date on current writing. Hopefully the last issue of 2019 will comprise papers presented at the International AIDS Economics Network meeting just ahead of the International AIDS Conference in 2018. To some extent this will be a ‘development’ issue as some of the authors have not published before. Steven is one of the two guest editors for the issue.

I am teaching two courses this term and am increasingly aware of the importance of equity in health. It is quite clear that, in the near future, a number of countries will not be able to afford to have their citizens on antiretroviral therapy. Donors are paying for it and may step back. This will raise a series of moral questions and it will be deeply interesting and concerning to see how they are addressed. My belief is that donor agencies will agree to continue funding people who are on treatment, but they probably won’t initiate new patients.

The big news from Waterloo is that the light rail service is finally in operation. This means that there are spanking new two-car trains running from a mall to the north of Waterloo to one to the south of Kitchener. I find it quite telling that the endpoints are shopping emporia. The train has been free of charge for the first 10 days of operation, giving the local citizens the opportunity to try it. In general I believe large infrastructure projects are critical for long term development, although it may not seem so at the time.

The construction was a period of disruption for the region. I think, in the end, it took close to three years but brought jobs and a huge amount of money to the two cities. There is a major road and rail intersection next to my office. Every time a train goes through, the boom gates come down. Traffic comes to a standstill, not just cars and bicycles, but pedestrians as well. This is possibly the only disadvantage of the system. It may, however, be an additional reason for people to get out of their cars and onto the trains. It also provided an interesting example of clear thinking by the city officials who control the traffic flows. There was a yield sign for traffic turning left and merging onto the main road. For a period of about two days the rule was all traffic should stop when the light was red. This meant a line of cars extending back probably over a kilometre. The local authorities took note and have returned to the ‘yield’ option and the traffic is flowing again.

Over the last week of June the news was dominated by incredibly hot temperatures in Europe and later the UK. In Canada it has also been extraordinarily warm and rather humid. Does climate change exist as an issue? On the radio and television scientists are quick to say we can’t point to one event as proof of climate change but if you look at the trends around the world it seems pretty clear. What I don’t understand is how there can still be climate change deniers. Even the employees of the oil companies have to live in this world. Surely they recognise it is a different one from the one we grew up in. In my opinion people are unwilling to address this for many reasons. One is that, if the world is going to end, what is the sense in saving, investing, putting money in pensions, and having and educating children. The future must offer hope.

On Saturday the 29th I had some friends over for what I call a braai, and they call a barbecue. There is a flat area on the roof of the apartment block with a gas-fired barbecue. It is a great opportunity to gather, cook, and generally relax. I get my meat at ‘Charles Butchery’ who sell from a stand at the Kitchener Farmers’ Market. This is open on a Saturday through the year, and one can always get meat, fish and vegetables. At this time of the year they have local fresh produce which is particularly tasty. I found myself taking the organic options where possible. The reasons are: I can afford it; and if enough people do this then the organic farmers can stay in business and, hopefully, even make a decent living. It has been telling to see the dramatic increase in awareness of plastic and the harm that it causes over the past two years. Paper bags are increasingly an option.

My Saturday was actually very busy, in addition to the social event and visiting the Farmers’ Market I drove over to Canada Computers to buy new headsets for my dictation software. The padded earpieces on the headset I currently use have become so worn that I end up with sore ears. The shop only opened at 10 AM but I was one of the first people there. The other stop was to get some wine from the LCBO. This stands for the Liquor Control Board of Ontario. This is a Crown corporation that holds a monopoly on the sale of all alcohol throughout the province of Ontario. It does seem a rather odd set up, but the rules are changing to allow other shops to sell beer and wine. I am rather boring because at the moment the wine that I drink, but not to excess, is a South African one called Grinder. It is not too expensive and when I am entertaining, I can empty a couple of bottles into the decanter and keep it topped up.

Inevitably during a teaching term I am on the lookout for books that I can share with the students. I have been compiling a reading list and it has been striking to me to realise how out of date many of the books on my shelf now are. It seems like just yesterday that they were published. This includes some that I thought were going to be seminal. I have just finished two books: Barbara Ehrenreich, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, published by Twelve in 2018; and Beth Macey Dopesick: Dealers, Doctors, and the Drug Company that Addicted America published by Little Brown in 2018. The second one is about the epidemic of prescription drugs which has swept across North America.