B u l l e t i n - Noble and Greenough School

are aligned with what we know about
the epidemic as well as the research that
is happening elsewhere in the world.
hs: You’re bilingual. What’s your
second language?
tm: I’ve never been very good at languages.
I learned the local language of
the Gambia—Mandinka—mostly in
the context of communicating with my
host family [in the Peace Corps]. It’s a
spoken language. It’s not traditionally
written or read.
hs: What work are you especially
proud of?
tm: One of the things I’ve been working
on over the last few years is making
an impact in Nigeria. Nigeria has the
second-largest number of people living
with HIV. Only about 3 percent of Nigerians
are HIV-positive, but in terms
of sheer numbers, it’s a huge epidemic.
One of the things we’ve been trying to
do at USAID is to realign the programs
to make sure that we have the
greatest possible impact. In the last few
years, we’ve been working closely with
the government to realign the portfolio
to match specific epidemics.
hs: What’s your expertise within
your expertise?
tm: A lot of the papers that I’ve published
in the last few years are related
to something called concurrency: a social
or sexual networking pattern where
people tend to have more than one sexual
partner at the same time. They’ll
have a husband and two boyfriends, or
they’ll have a wife and three girlfriends
for long periods of time. In the U.S. we
tend to see that people have one partner
for a period of time, will break up
with that person, then start another
28 the Nobles bulletiN spring 2012
partnership. In southern Africa, you
tend to see a larger proportion of people
who will have two or three partners
for a long period of time, and the theory
is that this type of patterning in sexual
partnerships makes HIV a lot riskier:
You have an established sexual network,
and you drop HIV into it, and it
spreads rapidly. We think this is one of
the reasons why HIV in southern Africa
has spread much faster than in other
parts of the world.
In South Africa, where I did my
Ph.D. research, I found that between
13 and 38 percent of the population
was engaged in more than one partnership
at the same time. And so one of
the things we’ve been working on is to
create awareness about the risk. It’s socially
tolerated—though not always
accepted—that people have more than
one partnership. The assumption has
always been that if you have lots and
lots of sex partners, then you’re at risk
for HIV. We’re increasingly finding
that it’s not just the total number of
people you have had sex with, but it’s
how those people are spaced over time.
If they all overlap, your risk is a lot
greater than if they are spaced out. We
are trying to raise awareness about that.
It’s a social and cultural norm, and it’s
very much tied in with broader economic
issues, such as poverty.
Part of changing behaviors is that
it’s really hard to measure [progress]
over time. When we look historically at
the HIV epidemics in Africa, we see
that a lot of programs [aimed at prevention]
have been happening and, five
or 10 years later, you start to see a decline
in HIV. The best example of that
is in Uganda, where there was a large
community response, and several years
later we started seeing behaviors
change, and several years after that we
started seeing HIV go down. We can’t
make a link between a single behavioral
program and a decline in HIV, but we
do see trends that indicate that these
programs can work.
hs: What big idea ties together your
work and personal aspirations?
tm: The work that I do now in my professional
life is something I’m passionate
about. I’m lucky. I get to spend a lot
of time on the road, traveling and seeing
new places. The world is a huge
place, and I want to try to see as much
of it as I can. It’s a great opportunity
for me to do this work and travel at the
same time. It’s a great match for how I
want to live my life.
hs: What does success look like?
tm: Well, in the next five or 10 years,
I’d really like to see some of the HIV
epidemics start turning around—and
turning around more dramatically. I
want to have been a part of something
much bigger [than my own work].
In the field, you see some of the
poverty and basic living conditions and
recognize that HIV is just one problem
among many in the countries where I
work. But when I was in the Peace
Corps, the community I lived in was
one of the happiest communities I’ve
ever known. We were living in mud
huts and didn’t have toilets, but those
weren’t the things that mattered.
There’s a deep sense of community and
taking care of one another, and you
don’t see that in a lot of places. As hard
as life can be, there are always bright
things in the future. It reminds you to
appreciate all that we have.
It’s incredible how little it can take
to be happy.