The Crisis of AIDS in South African Children

Show: FRESH AIR
Date: DECEMBER 01, 1998
Time: 12:00
Tran: 12040303.217
Type: FEATURE
Head: Doctor Hoosen Coovadia
Sect: News; International
Time: 12:06

This is a rush transcript. This copy may not
be in its final form and may be updated.

TERRY GROSS, HOST: This is FRESH AIR, I'm Terry Gross.

Today is World AIDS Day. Here in the U.S., new drugs have helped many people with AIDS continue on with their lives. But these drugs are too expensive for the most hard-hit part of the world, Southern Africa.

The statistics there are horrifying; in several African countries nearly one in four adults has AIDS. This year in sub-Saharan Africa two million people died of AIDS. Over half of the people who were infected there this year live in South Africa.

My guest, Dr. Hoosen Coovadia treats South African children with AIDS; he's the head of Pediatrics at the University of Natal Medical School. He's also of the Chair of the next International AIDS Conference which will be held in South Africa in the year 2000.

Forty percent of the children in Doctor Coovadia's hospital have HIV; almost all of them got it from their mothers during labor or through breast feeding. I asked Doctor Coovadia to describe his hospital.

DOCTOR HOOSEN COOVADIA, CHAIRMAN, WORLD AIDS CONFERENCE, YEAR 2000: It's an old apartheid structure which meant it was meant for Africans and mostly people who are not white. Nowadays, it's nearly always Africans who attend; so, therefore, it is not a well endowed hospital. But it's one of the largest hospitals on the continent, it used to be more than a 1500 beds - it's a huge hospital.

Its so-called "teaching hospital" -- so-called. It's meant to be a hospital which trains doctors, and nurses, and post graduates so that's why we call it a teaching hospital. But apartheid ensured that the resources went to hospitals which were often treating White patients.

So, many hospitals in Johannesburg, Cape Town, Bloemfontein, etc. which were previously for the exclusive use of Whites were much better endowed. This is a dreadful place, but we do our best.

GROSS: What kind of treatment can you give the babies and the children who have AIDS?

COOVADIA: I think we -- we give them what is available to children who are not HIV-infected. That's -- in a nutshell that's what transpires. I guess in most developing countries -- in most of the African countries I've been to it's similar to what happens here that is the diseases they have -- common diseases; they have diarrhea which is common in HIV uninfected children; they have pneumonias which are common in uninfected children, and so on and so forth.

So, they simply slot in to the routine treatment of children, and that's what we do for them. I think that there is much more we can do, but at the moment the resources haven't been provided certainly to us to guarantee or to promote the additional treatment that children with HIV require.

GROSS: If you had more money and more resources what would you be able to do for the children?

COOVADIA: Oh, I think we'd make their lives infinitely better. There are things that we could do that are being done in the U.S. for example, and when I see the results of that -- the lives of children in the U.S. are far far better and catered for than the children we see over here.

For example, the use of anti-retro viral drugs in children is proven to have multiple benefits, it's not just an attack on the HIV virus which it does efficiently -- which these drugs do efficiently. So, you reduce the load of the virus in the baby, and therefore you make the baby better.

But, the child recovers from other diseases more rapidly; the child grows better; the child feels better. And so, these innumerable benefits accumulate just from anti-retro viral therapy which is not available to us, it's not available to nearly all of the countries in Africa that I've been to.

So, that's simply at the level of the provision of anti-retro virals, but there are other things we could do; there could be better care in the homes which is cost-efficient which means it's often affordable in developing countries; care for children at home; more follow-up by some type of health worker -- doesn't have to be a professional health worker -- in their homes to make their lives a bit easier; to care for the repeated infections for the failure to grow; the thousand and one other problems they have.

So, that sort of community outreach program is simply not available even in South Africa which is not as poor as most of the countries in Africa, it's a relatively resourceful country; it's a middle income country if you wish, more on the scale of places like Brazil and Thailand, and so on.

So, we don't have that outreach program either; we don't have the sort of clinic support by which I mean a dedicated group of doctors specifically identified group of nurses; social workers; occupational therapists. You name the whole range of problems because these kids have almost every organ involved, you need a wide range of disciplines to cater for them.

If I had that -- if I had a unit which looked after these children I could provide much much better care, but we simply don't have it. And I can understand the government's difficulties when it has to decide on priorities.

Do you decide on priorities which deviate or divert funds from children who are uninfected towards children who are infected? It's a difficult decision to make.

GROSS: Is their a split in South Africa between the haves and have nots, and the kind of health-care that they receive if they have AIDS? Now, is there a split between the typical, say, the White middle-class persons access to AIDS drugs and the typical Black persons access to be AIDS drugs now?

COOVADIA: No question about it. The problems of apartheid are going to take a long long time, and one of those affects of apartheid which persists to today; the access to resources. There's no question that the privileged who are mostly, but I must insist that is not entirely, mostly White still continue to today; and it's going to continue for a long time.

And that's a reality across the board; so, whether it's access to justice, or education, or housing, or income, or whatever those disparities still persist, and they will persist for a long time. And, therefore, manifest itself in inequalities to access to health care for AIDS too.

However, there is a difference that -- HIV's AIDS is not a major problem in the White population. Nor, in fact -- we have a large number of people of Indian origin here too -- it's not a major problem in those populations. It's really overwhelmingly a problem in Black African -- South Africans, if that's the right term, but that's the group.

So, the children who are infected are nearly all of African children, and they, as I've indicated, get very little in terms of care.

GROSS: Why do you think, in South Africa, HIV has particularly struck the Black population and the White population much less so?

COOVADIA: I think it's an effect of the way the disease spreads. So, if you wish, in medical terms of its the epidemiological pattern of the disease. It's the social basis of the disease, and probably it's the economic basis of the disease.

But I don't believe, and I don't think many people who deal with the disease believe that it's simply a question of poverty -- it's not that, it's not that.

AIDS makes the life of poor people infinitely worse -- and makes it much worse. So, it flourishes amongst the poor, and the poor people have less access to health-care so they suffer more and they get more of the problems of HIV AIDS.

They have less access to health resources so they don't get treatment, they may have less education so they don't have the incentives to use preventive measures. So, poverty exacerbate AIDS, however, AIDS doesn't depend on poverty alone because well-off people also get HIV AIDS.

And if we look at Africa, the example is starkly clear; one of the better off countries in Africa is Botswana. Compared to much of the rest of Africa. The rest of Africa is far worse economically, and yet the prevalence of HIV AIDS is highest in Botswana compared to most of the other countries and Africa which are far poorer. And that applies also within countries so it's not simply a question of poverty.

GROSS: If you are just joining us my guest is Doctor Hoosen Coovadia, and he is the Chairman of the next World AIDS Conference in the year 2000. And he's the head of Pediatrics and Child Health at the University of Natal Medical School in Durban, South Africa.

How have you seen the number of AIDS victims grow in the years that you've been at this hospital in Durban?

COOVADIA: Exponentially. When it started, the epidemic in South Africa was first amongst White men who had sex with men. So, it was a small epidemic, and around the late '80s -- it must of been around 1988-89 we began to see the first cases of HIV infected children.

So, that was obviously the first expression of the AIDS epidemic in the heterosexual population which is the major form of the disease in this country. And we've seen a rise which is absolutely striking, I mean, it is so steep; from virtually zero -- virtually zero in, let's say, 1988 -- no cases, no experience. I didn't even know what a case looked like of HIV, I didn't know what a child with HIV AIDS might look like.

From 88 until now we -- roughly, about 40 percent of our wards are filled with people who've got HIV AIDS. And it's not just Pediatrics, it also applies to adults. We've been following up with pregnant women in our hospital, and have seen a similar startling increase of HIV amongst pregnant women.

And those pregnant women are also almost exclusively African -- Black African. And from a percentage -- it must have been under one percent in about 88-89. About 27 to 50 percent of pregnant women in our anti-natal clinics are now HIV infected; that's a phenomenal number. It almost translates to about one in three pregnant women who come to our hospital have HIV.

So, its sweeping through our wards, as its sweeping through the wards in Zimbabwe, Zambia, in Malawi, in Kenya, in Uganda, and virtually any other country in Africa which has got a high prevalence of HIV in the adult population.

GROSS: My guest is Doctor Hoosen Coovadia, head of Pediatrics at the University of Natal Medical School in South Africa. We'll talk more after our break.

This is FRESH AIR.

BREAK

GROSS: My guest is Doctor Hoosen Coovadia, head of Pediatrics at the University of Natal Medical School in South Africa. And Chair of the next International AIDS Conference.

What have you had to do at the hospital to prevent the spread of AIDS within the hospital?

COOVADIA: I don't think the disease really spreads within the hospital; I don't think that happens. I think the hospital is really the source of provisional care, and as I've indicated, that care, I think, is inadequate because of lack of funds.

But you may well ask, what are we doing about the reduction of the load or the burden of the disease, and that's where we've been trying our best to get to an answer which is appropriate, not only for our country, but for Southern Afriaca and hopefully for the continent. And maybe even relevant to all developing countries.

So, we've obviously been very impressed with superb results of the American and French studies which can prevent HIV in children by treating the mother with an anti-retro viral - AZT.

So, that experience really was -- it was a seminal event, and it meant that we had to now look at the possibilities because for the first time we now had the possibility of preventing AIDS.

Almost better than a vaccine because if you prevent it in a baby, you prevent it altogether, and we are, I guess, on the brink of determining the rights or policies which apply to our country.

So, ever since that trial in the States and in France which was known as AZTG076 many groups throughout the world, including ours, working independently; working with UN aids; working with CDC; working with numerous agencies helping addressing the question of what's the best regimen of anti-retro virals to produce a similar effect in developing countries.

Similar effect because we don't think AZTG076 can easily be applied for a number of reasons to Africa and other developing countries. So, we really have to find our own appropriate intervention -- anti-retro viral intervention.

GROSS: Why don't you think it will work in South Africa?

COOVADIA: There has been a long debate about that, and to cut a long story short; there are a number of reasons. One set of reasons is logistical, that is the way the study was designed in the U.S. and France it depended on having good anti-natal clinics services; it depended on having early attendance at anti-NATO clinics; it depended on having facilities at these clients for giving intravenous injections.

So, there were these logistic reasons which made it impossible to translate that into poor countries, especially developing countries in Africa. The second reason is that the population had different risk factors; for example, in the States and in France you could discontinue breast feeding, and therefore remove a major source of transmission without causing too much harm to the babies.

Now, you can't do that in Africa, or Asia, or some other poor countries. Breast milk is a really important food, it's a nutrient. In fact, it's the only nutrient which may be available to thousands and thousands of women to Africa.

They either cannot afford to buy another type of milk like a formula or they may be unwilling to change because breast milk is not just an ordinary contact between mother and child, it's deeper -- it's got huge cultural connotations, and it's been there traditionally for ages.

And, as I said earlier, that some women just won't have a choice. Formula heating is not cheap because it costs a lot of money, and people in Malawi, and parts of South Africa, and Zambia, and Uganda simply would not be able to afford that.

So, it was important to look at the role of breast feeding and how we can address it. And I must say we haven't succeeded yet; we have a rough idea of what we might be able to do, and we might be able to recommend avoidance of breast feeding under special conditions; UN aids and WHO and UNICEF have made certain recommendations that they do that.

But at the moment, we don't have the perfect plan for reducing mother to infant transmission. As I said, 076 has these logistic problems, it has the problems of breast feeding. There are other biological factors. The factors that cause transmission between mother to infant might vary between developing and developed countries.

And lastly, the cost of these AZT076 is simply unaffordable in large parts of Africa. So, for those reasons that regimen was inapplicable to developing countries. There are a number of other alternatives; the UN AIDS study I spoke about is using not only AZT but another drug called 3TC, and those results will be out soon; and so on and so forth.

So, I think in the space of about a year, or a year or two, developing countries -- governments in developing countries and protagonists for the reduction of mother to infant transmission will have a set of options before them. And they will have no excuse, to my mind, no excuse whatsoever for not choosing one of those options.

GROSS: So, the drug that you were talking about is a form of AZT?

COOVADIA: It is AZT, yes. But it is AZT sometimes combined with another drug and that's called 3TC. Those results are still not available, but will be available soon.

GROSS: I imagine that many of the people who you see at the hospital are very poor, and that probably a good deal of them are uneducated. With that be a fair the assumption?

COOVADIA: You're quite right. The -- as I said before, the effects of apartheid persist to today, and the public hospitals where people like me work are really hospitals which are frequented by the really poor; people who don't have medical insurance or don't have their own incomes to pay for private medicine.

So, inevitably it is African children and it is really the poorest of African children. You know, in a phrase it's really the poorest of the poor. So, they have very very little resources.

GROSS: What kind of problems do you have trying to explain what AIDS is to the parents of the children who you treat or to the children themselves if they're older enough to explain it to?

COOVADIA: If you imagine that about 30 percent of women who have got HIV, and that this has been around now for about 8, 9, 10 years; most African people know about HIV AIDS. They understand it, and many of them have a fair idea of how it's transmitted. So, that is not the problem; I think they understand it, and, in fact, it strikes fear in their hearts.

The problem is: how do you get over the other difficulties in revealing this information, and so on? The knowledge is not the problem.

GROSS: What do you mean by revealing the information?

COOVADIA: Well, they know how it's probably spread; they know the dangers of HIV, but it is not a socially acceptable disease in many many instances. So, it is not a neutral matter for a woven to go home and say to her husband, lover, or family that I have got HIV AIDS.

It creates a whole lot of problems with them at home, and there are instances where women are prejudiced, they're discriminated, they're abused, they're expelled. Their affairs come to an end, marriages break, and so on.

So, they have to take that into consideration, and it ultimately depends on the individual woman if she thinks she belongs in a family environment where she can share these secrets. It's not an obvious thing that she can. So, we have to be very careful about advising her what to do about revealing her information.

GROSS: Doctor Hoosen Coovadia is head of Pediatrics at the University of Natal Medical School in South Africa, and Chair of the next International AIDS Conference. He'll be back in the second half of the show.

I'm Terry Gross, and this is FRESH AIR.

BREAK

GROSS: This is FRESH AIR, I'm Terry Gross.

On this World AIDS Day our guest is Doctor Hoosen Coovadia, he is Chair of the next International Aids Conference which will be held in the year 2000 in South Africa. He is also the head of Pediatrics at the University of Natal in South Africa.

His country has been very hard hit by the epidemic; about 40 percent of the children in his hospital have AIDS. Almost all of them got it from their mothers during labor or through breast feeding.

Now, how do most of the women who have AIDS in South Africa getting the disease?

COOVADIA: They are getting it from men, simple as that. Women -- the studies that have been done here have shown that women are mostly monogamous - mostly. And, therefore, they have -- only a minority of women -- a small minority of women would have AIDS HIV infection because of promiscuity.

They are getting it from men because, for many reasons, men have more sexual contact, and that sexual contact leads to the infection of this virus. The sexual contact is often with commercial sex workers.

It may be with other women who have casual sex, and therefore they are infecting -- the men are infecting, and they come -- and come back home sometimes and infect the women.

So, it's -- in a way it's the vulnerability of women which exposes them to the risk of HIV in South Africa, and, indeed in all of Africa. So, it's the real -- it's the ultimate form of oppression of Black women.

GROSS: So, if I'm hearing you right that it's often a husband who infects the wife, and then if the wife get sick she is expelled from the house for being sick even though she got sick by contacting it through her husband?

COOVADIA: Well, I'm not sure if it's such a straightforward, linear relationship. What I'm saying is that's the usual way they get infected. It's usually from the men -- the men have got, and we can discuss that a little later, but they are infected under their own circumstances; they pass it on to women.

But, generally speaking, because women depend on men for their livelihood they are generally less educated, they have less opportunities for getting jobs, they therefore have less income. There are a whole lot of cultural pressures to keep them in their families so they are entirely -- often entirely dependent on men.

And, therefore, revealing an HIV status is quite a momentous business for a woman in that position. And, when she's infected she is infected because she can't deny sex to a man who has such control and power over her.

She can't insist on fidelity, in fact. She can't insist on knowing if he is exposing himself to other women who might be infected. She often doesn't have that power.

GROSS: How widespread is condom use in South Africa, in the population that you treat which is mostly poor people?

COOVADIA: It's -- I'll try to give you an accurate estimate because it is not -- we don't have that sort of data, but as far as the government is concerned there is a national AIDS program like there are national AIDS programs in much of Africa, and they have distributed millions of condoms, and they are available free of charge.

It's not to say they are easily accessible to men, but they are available. I don't have figures, but generally there are anecdotal accounts one has which means that if you -- small studies that have been done suggest that condom use is not widespread.

GROSS: I heard that the South African government bought about 1.5 million female condoms. Do you know what the result of that was?

COOVADIA: They did. They had some difficulties in the beginning because there were some problems about the usefulness of those, but they started using them and they've been testing the acceptability by women.

And I understand they are acceptable by women, but I don't think there are any sufficiently rigorous impact studies to give you information on whether they are effective or not. But, I think, you know, they're likely to be effective, but we will have to wait a while to see how good they are.

GROSS: Now, I know you recently toured several other African countries; just a few weeks ago you toured Zambia which is one of the countries most hard-hit by the AIDS epidemic. Could you share with us some of what you saw there?

COOVADIA: I think to look at the impact of AIDS outside of the hospital, it gives you a good idea of the devastation it's causing in communities, and I think that's what Zambia taught me at least.

I was there for a different purpose, but what it showed when I looked around at the figures is that Southern Africa is at the real epicenter of this epidemic, globally.

And about 70 percent of all the HIV cases in the world -- there are about 13 million -- 70 percent of them are in Africa. And most of them are in Southern Africa.

So, here we sit at the very raging vortex of this epidemic, and you see it in the figures which indicate the regression in the development of human beings that we have been achieving in the last, say, 20-30 years.

So, you see it in the fact that people live shorter lives, and not just one or two years, but on average because of HIV AIDS in the more severely hit countries like Zambia, by 16 years. So, whereas they might have lived to, say, 66 they now live -- sorry, die at about 50.

And Zambia which I visited, has more people dying in that age group than who are dying of older age. That is older than 50; it's a pattern which has virtually never happened in the history of infectious diseases amongst humans.

GROSS: I recently read that although many people have a concern about rising population rates in African countries that because of the AIDS epidemic in Zimbabwe that population is expected to start declining in about four years because the country has been so hard hit by AIDS, and that's a really almost shocking reversal in population trends.

COOVADIA: I think so. That's true for some countries in Southern Africa. It hasn't happened yet, but certainly -- you must remember that the people who we are seeing infected now were infected, let's say, 10 years ago; that's 1988.

And the figures then in 1988 we're no way like they are now. So, if you imagine that roughly one in four adults in Southern Africa -- one in four adults walking in the streets, going to work, going to school, playing, etc. -- one in four is infected now, can you imagine the horror of death rates, etc. in the next 10 years when they will start dying? In a phrase, really, the worst is still yet to come.

GROSS: If you're just joining us my guest is Doctor Hoosen Coovadia, and he's the Chairman of the next World AIDS Conference scheduled to be held in the summer of the year 2000.

He's also the head of Pediatrics and Child Health at the University of Natal Medical School in Durban, South Africa where he says that about 40 percent of the children that he treats have AIDS. We'll take a short break here and then we'll talk some more.

This is FRESH AIR.

BREAK

GROSS: Back with Doctor Hoosen Coovadia, he's Chairman of the next World AIDS Conference in the year 2000, and head of Pediatrics and Child Health at the University of Natal Medical School in Durban, South Africa.

Doctor Coovadia, you're the Chairman of the next World AIDS Conference which will be held in the summer of the year 2000. What are some of the issues you would like to see addressed at the conference, and I believe it's going to be held in South Africa?

COOVADIA: It's going to be held in Durban, actually.

GROSS: Oh.

COOVADIA: And the reason that we're rather pleased that it's coming here is that up until now it's never been held in a developing country. And as I indicated to you before, 70 percent of the problems are in developing countries.

So, in Africa about 90 percent of the problem is in developing countries. So, here we have a disease where nine out of ten cases are amongst the poor nations of the world, and the conference is held in the rich countries of the world.

It's a paradox which is obvious, and which needed to be addressed. So, that's why we are glad, and we thought at least South Africa had, I think, the infrastructure and the facilities to hold the conference - that was important.

And secondly, to hopefully refocus some of the priorities of the conference and to bring to the floor issues which are really important to poor Black women in Africa, to women in Asia, even women in China, and Latin America.

To talk about the difficulties of cultural constraints, about community responses, about family support, about the lack of availability of basic resources, the inability to get drugs, and so on and so forth. To refocus the issues for the people who matter most with this particular disease.

GROSS: What are some of the other cultural issues that you'd like to raise at the conference?

COOVADIA: There's another huge issue which affects the transmission of HIV in Africa and that is the migration of people through international borders. Remember, I said that men get infected. Why do men get infected in Africa and not in Europe and so on?

It's because -- often because the social dislocation of these migrations UN aids, for example, in a draft document have calculated, I think, that there are something like 58 million migrants -- forced migrants that people who didn't really want to leave and have left.

So, that's a huge population, and South Africa is par excellence an example of the devastating effects of such forced migration on people. Remember, our colonial history was such that men from neighboring countries came to work on our mines, and those mines still exist.

And most of those men live in single sex hostiles, you can then imagine the destruction of family life, the casual sex -- the casual attitude to sex; the role of commercial sex workers to satisfy the sexual needs of these men who work in mines.

That's going on every day, and that's exacerbating or may be fundamental to the problem of the spread of HIV AIDS amongst Black men in Southern Africa.

So, that's an issue that we really need to discuss. It's a problem that's not easily resolved because it goes to the heart of the economic infrastructure of many in our society, but I think it must be addressed.

GROSS: What is your best hope for reversing the epidemic in Africa?

COOVADIA: At the end -- at the end, I think a vaccine which is -- which works in African populations, which is not too costly, which is cheap, which can be delivered appropriately to people on the African continent. I guess that is going to be our salvation, if you wish, for people who are not infected.

That is some years down the line, but in a way when I look at the use of condoms, the treatment of sexually transmitted diseases, and so on they do have an impact, and we, of course, must continue. But if you really want to make a major impact, I think a proper vaccine is going to be the answer.

For children, as you know, we can achieve wonders with anti-retro virals when they are properly and appropriately given.

GROSS: How optimistic are you that we'll have a vaccine in a few years?

COOVADIA: No, I'm not. I don't think it will come in a few years. I think -- I have a sense it will come, but it won't come under a decade, I don't think so. So, we'll have to live with this problem -- I don't think the rates of increased HIV will continue, it's not sustainable that way.

I think the addressed populations get saturated, and, therefore the epidemic may level off. You'll get many more people dying so the number of people with HIV AIDS will not necessarily increase at the rate it has been for the past 10 years. So, I think we are in for a rough time for the next 10 years or so.

But, hopefully, we won't make the mistakes or repeat the mistakes of the past in creating vaccines which become unavailable or inappropriate, or don't work in populations in Africa, and Asia, and Latin America.

GROSS: This is world AIDS day, and one of the founders of world AIDS day Jonathan Mann died a few months ago in a plane crash going to an AIDS related conference in Geneva. I'm wondering how his death affected you and your work?

COOVADIA: I didn't know him personally, but I knew about his work. And I think the things he stood for really mattered to me. I think he stood for the public health, the humane issues related to AIDS, and I think he devoted his life to that.

I heard him speak on a number of occasions and he reflects a sort of views that you heard me expressing here; not just a biological management of the problem, but a social, economic, humanitarian, cultural management of the problem.

He had a vision of control of HIV AIDS which is rather rare amongst people in the world of his standing, and he was an extremely valuable individual in the fight against AIDS. I think we'll miss him because of that.

GROSS: Well, Doctor Coovadia, I wish you good luck with the planning of the World AIDS Conference in the year 2000, and thank you very much for spending some of this World AIDS Day with us and telling us about your work in South Africa.

COOVADIA: Thanks very much.

GROSS: Doctor Hoosen Coovadia is the head of Pediatrics at the University of Natal Medical School in South Africa, and Chair of the next International AIDS Conference which will be held in the year 2000.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 888-NPR-NEWS

Dateline: Terry Gross, Washington, DC
Guest: Doctor Hoosen Coovadia
High: Doctor Hoosen Coovadia is a Pediatrician in Durban, South Africa. In his practice, 40 percent of the kids he treats are HIV positive. He'll discuss the rise of HIV in South Africa and other parts of the Africa where he has traveled. Coovadia will serve as the Chairman of the next World AIDS Conference in the year 2000. He heads the Pediatrics and Child Health Department at the University of Natal Medical School.
Spec: AIDS; Africa; Doctor Hoosen Coovadia; Children

Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Doctor Hoosen Coovadia

Show: FRESH AIR
Date: DECEMBER 01, 1998
Time: 12:00
Tran: 120101np.217
Type: FEATURE
Head: Ken Tucker
Sect: Entertainment
Time: 12:52

TERRY GROSS, HOST: PJ Harvey is the name for a loose coalition of musicians led by the English singer-songwriter and guitarist Polly Jean Harvey. Her work has been extravagantly praised for its intensity and its refusal to adhere to any one genre of pop music.

Now in her late twenties, Harvey has just released her fifth album called "Is This Desire?" Rock critic Ken Tucker tries to answer the question.

(BEGIN AUDIO CLIP -- SINGER/MUSICIAN POLLY JEAN HARVEY)

Don't you see her walking
Don't you come around here sir
Black hair brown eyes
You're beautiful when your

(Audio gap)

Said I don't have no one
Even when I held her
She went out looking for someone
Looking for someone

KEN TUCKER, ROCK CRITIC: Polly Jean Harvey is the daughter of hippy leaning parents from Dorsetshire (ph); a mother who's a sculptor who also produced local blues concerts, and a father who's a quarryman.

One of the first things Polly Jean did after becoming a pop music sensation in England was to take opera lessons. This, clearly, is a woman who knows how to go her own way, and more than any current rock performer of either sex, she knows how to get the maximum effects out of extremes of sound.

She's tremendously skilled at establishing a mood and building on it, and she does here on "The Wind."

(BEGIN AUDIO CLIP -- SINGER/MUSICIAN POLLY JEAN HARVEY PERFORMING "THE WIND")

(Unintelligible) places
I am (unintelligible)
He's making noises like whales
Noises like whales

He built a chapel
With her image
(Unintelligible)
Places where she could rest

And rest
And a place where she could wash
Listen to the wind blowing
And listen to the wind blow

And listen to the wind
Torture on the wheel
(Unintelligible)

TUCKER: Many of Harvey's songs on "Is This Desire?" are sung in the characters of different women or are songs addressed to women in different tones; comradeship, jealousy, sympathy, rage. She plays around with gender roles, her previous album had a gleefully aggressive song called "Mansize."

In all this, she's more comparable to a contemporary short story writer like Mary Gaitskill than to your average rock star. I think a gritty realist like Gaitskill would really appreciate the opening image in a song like "Catherine" in which Harvey says "I gave you my heart, you left it their stinking."

(BEGIN AUDIO CLIP -- SINGER/MUSICIAN POLLY JEAN HARVEY PERFORMING "CATHERINE")

Catherine (unintelligible)
Clouded my thinking
Gave you my heart
You left the thing stinking
Escaped from your spell
And weren't for my drinking

The wind bites
With each bite of morning
I envy the road
The ground you tread under

I envy the wind
Your hairline remover
I envy the pillow
Your head rests and slumbers

I envy your (unintelligible)
I envy your lover
Tell a lie it sheds on me
(unintelligible) every second you breathe

Tell a lie it shines on me
(unintelligible) every second you breathe

TUCKER: Two different reviews I've read of "Is This Desire?" have referred to Harvey as the Emily Bronte of rock which I don't think quite gets it.

True, there's a large element of the Gothic -- the Gothic romantic in her work, but there's little of the fragility or hopelessness that underpins Brontes well-written melodramas, and I don't mean melodrama as an insult here.

As for an answer to the question she asks in her albums title; well, in the title song she wonders whether her love contains enough desire. Enough, as she says, "to lift us higher." Which I take to mean a higher plane of feeling and consciousness.

At her best, Harvey demands that you and I answer in the affirmative. This really is the sound of desire.

GROSS: Ken Tucker is critic at large for "Entertainment Weekly."

I'm Terry Gross.

This is a rush transcript. This copy may not
be in its final form and may be updated.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 888-NPR-NEWS

Dateline: Terry Gross, Washington, DC
Guest: Ken Tucker
High: Pop critic Ken Tucker reviews "Is This Desire" the latest release by the English singer, songwriter and guitarist Polly Jean Harvey.
Spec: Entertainment; Music Industry; Polly Jean Harvey

Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Ken Tucker

Show: FRESH AIR
Date: DECEMBER 01, 1998
Time: 12:00
Tran: 12040403.217
Type: FEATURE
Head: Maureen Corrigan
Sect: Entertainment
Time: 12:45

TERRY GROSS, HOST: Literary scholar Harold Bloom says that almost daily for the past 12 years he has read and taught Shakespeare's plays, and he's come to realize that the accurate stance towards them is one of awe.

Book critic Maureen Corrigan says that's also her stance toward Bloom's latest book called "Shakespeare: the Invention of the Human."

MAUREEN CORRIGAN, BOOK CRITIC: Some detractors say that like Hamlet, Harold Bloom is long winded. Indulging in gassy digressions that bloat his book. Others sneer that like Leer without the Fool to watch over him he's grown old and cranky, railing against feminists an deconstructionists who refuse to stand naked beside him on the heath stripped of theory and footnotes.

Some serpent tongued wits have even compared Bloom to his idol William Shakespeare, hastening to hiss that, like the Bard, he cares too much about making a buck, and thus writes too quickly.

There may be some truth in all these charges, but set against Harold Bloom's colossal critical achievement in "Shakespeare: the Invention of the Human," they have as much chance of carrying the day Peaseblossom, Cobweb, Moth and Mustardseed would in a game of tug of war with Falstaff.

And, in fact, Falstaff whom the outsized Bloom adores, and physically resembles is his most fitting Shakespearean counterpart. Impassioned, opinionated, and wise, Bloom, like Falstaff, is a living rebuke to academic cant and cynicism.

Bloom, here, marshals a lifetimes worth of experience as a reader, scholar, teacher, and playgoer to brilliantly work through all 35 of Shakespeare's plays. As its bold title implies, however, "Shakespeare: the Invention of the Human" is no simple sentimental journey.

Bloom wants not merely to praise the Bard, but to arrive at some profound new appreciation of how Shakespeare created human consciousness. As Bloom declares towards the end of his mammoth book: "I do not know whether God created Shakespeare, but I know that Shakespeare created us to an altogether startling degree."

Clearly, this is one of those big think theses that can't be proven. Bloom's claims for Shakespeare are destined to stand or fall on the strength of his own language and interpretations. Bloom's writing here is radiant, alive with conviction, intelligence, gusto, and righteous contempt.

In particular, his comments on the many awful productions of Shakespeare he suffered through like Ray Fiennes recent travesty of a Hamlet have the acidic sting of a Sheridan Whiteside theater review.

As befits a patriarch of literary criticism, Bloom proclaims most of his insights as truths handed down from the mountaintop of his airy edition. This is a style that even Moses couldn't sustain for very long, but Bloom's pronouncements are so provocative they grant him the license to spout.

Here, for instance is one of Bloom's many written in stone remarks, this one on Macbeth: "Macbeth himself can be termed the unluckiest of all Shakespearean protagonists precisely because he is the most imaginative. With surpassing irony, Shakespeare presents the Macbeths as the happiest married couple in all his work."

Is Bloom right? Who knows. Doubtless some of his assertions are just so much sound and fury, other Bloomian tenants, however, will change the way many of us think about plays whose meaning had become fixed in our minds.

Nowhere is Blooms power as a reader more in evidence than in his discussions of Falstaff and Hamlet who, Bloom avows, manifest the most comprehensive consciousness in all of literature.

Bloom worships Falstaff without qualification, but he offers a startlingly revisionary criticism of Hamlet. The pale prince, Bloom says, loves no one. Not his father, nor Horatio, nor Ophelia, nor even the generations of audiences who've been transfixed by him in what Bloom calls the world's oddest love affair.

In the course of moving through the plays, Bloom chants the traditional Shakespearean cries of transcendence, and universalism in a largely successful, if temporary maneuver to drown out the ideological minded critics he so abhors.

Bloom growls: "Marxists, multiculturalists, feministists, nouveau historisists, the usual suspects know their causes but not Shakespeare's plays."

Leaving aside the vexed question of whether his denunciations are fair or not, it seems to me that what Bloom rightly dislikes about the younger generations of critics is their cool reserve; their guarded unwillingness to give themselves over to Shakespeare.

How refreshing it is, in contrast, to hear a credentialed critical genius like Harold Bloom admit to his romantic feelings for Rosalind in "As You Like It."

"Shakespeare: The Invention of the Human" may help bring Bardology back in fashion. It should certainly make Bloomoloters of many of its readers.

GROSS: Maureen Corrigan teaches literature at Georgetown University. She reviewed "Shakespeare: the Invention of the Human" by Harold Bloom.

This is FRESH AIR.

This is a rush transcript. This copy may not
be in its final form and may be updated.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 888-NPR-NEWS

Dateline: Terry Gross, Washington, DC
Guest: Maureen Corrigan
High: Book critic Maureen Corrigan reviews "Shakespeare: The Invention of the Human" by Harold Bloom.
Spec: Entertainment; Media; Harold Bloom; Profiles

Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Maureen Corrigan
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.