NHS under pressure from increase in cancer survivors, report warns

People are twice as likely to live at least 10 years after being diagnosed with cancer than they were at the start of the 1970s, new research shows.

More than 170,000 people in the UK who were diagnosed in the 1970s and 1980s are still alive – an “extraordinary” number, Macmillan Cancer Support said in its report Cancer: Then and Now.

The increase in long-term cancer survivors is due to more sophisticated treatment combined with an ageing population, the charity said, acknowledging that there was still a huge variation in survival rates according to cancer type.

But it warned the consequences were increasing demand on the NHS, with more people living for longer, with long-term side-effects. The Macmillan chief executive, Lynda Thomas, said: “More and more people are being diagnosed with cancer and, in general, having a more sophisticated life with their cancer than perhaps they would have done. What we are now seeing is that lot of people are coming in and out of treatment, so all of that does put pressure on the NHS.”

Related: How to get through chemotherapy: Decca Aitkenhead on cancer treatment

Around 625,000 people in the UK are estimated to be facing poor health or disability after treatment for cancer.

Long-term consequences can range from painful lower-leg swelling in women following breast cancer to emotional trauma, and with the number of people living with cancer in the UK set to grow from 2.5 million to 4 million by 2030, more people will need support.

Thomas said: “About one in four cancer patients will come out of cancer treatment with debilitating and very serious side effects … like incontinence, or experiencing serious sexual problems. Those are the things we tend not to talk about, but they can be the things that really result in people having a very poor life experience after their cancer diagnosis.”

The challenge for medical professionals is to “keep up to speed” with the potential side-effects as new treatments emerge, she said.

Some 116,000 cancer patients last year in England did not have the potential long-term side effects from their cancer fully explained to them, Thomas said.

Greig Trout, 37, from Thames Ditton, south-west London, who suffered cancer as a child: ‘I’m just trying to enjoy every day as it comes and just grateful to be here.’ Photograph: Karen Druy/PA

“It does happen from time to time, we will meet patients who’ve said: ‘I had no idea this was going to happen’. I hope that’s happening less and less now, particularly as professionals become better at explaining the consequences of treatment. But it’s important people recognise that issues such as fertility might be affected, or you might have heart problems later on in life. You never want to somebody to say: ‘I wish I’d known that before because I would have done something different’.”

Macmillan also estimates that there could be around 42,500 people who were diagnosed with cancer in the 1970s and 1980s who may still be dealing with long-term consequences.

After suffering cancer as a child, Greig Trout developed scoliosis, deep vein thrombosis and eczema. He struggles to put on muscle or fat in his upper body, has physiotherapy for his back and takes blood thinning pills every day.

Doctors believe his second bout of cancer, diagnosed when he was 30, could be a result of the radiation therapy he received more than two decades prior.

The 37-year-old from Thames Ditton, south-west London, said: “The life-saving treatment I had as a child has come back to bite me in the future, but I’m still here.

“I think GPs … it would be good for them, especially now with people who are struggling with side effects of treatment back in the 1980s, just to know and be more aware of what those side effects are.

“Developments of cancer treatment are just getting better and better, so I hope that more people don’t have to go through what I’ve been through as a child. I’m just trying to enjoy every day as it comes and just grateful to be here.”

NHS under pressure from increase in cancer survivors, report warns

We need better data on FGM, not propaganda | Letters

Professor Alison Macfarlane (Letters, 28 July) articulates statistical concerns regarding the Enhanced FGM Data Collection annual report and highlights misrepresentation of these flawed data by media. According to the report, the aim of these data is “to help the drive to eradicate the practice, and to provide services and support for women and girls who have had FGM”. A year on, it is evident that, despite claims made about the usefulness of the data, they are not fit for purpose. Collecting data at the point of encounters with clinicians is a futile way of collecting data about the population. It has previously been estimated that around 134,600 women with FGM live in England. The Enhanced Dataset collects data about 1% of these women each quarter. It is unclear how the data collected can be used to achieve the stated aims.

Patients disclose sensitive information when a safe, confidential space is created. It can take years for women with FGM to seek medical help. Clinicians are concerned that mandatory collection of confidential information without consent will damage trust in the doctor-patient relationship and discourage women with FGM from seeking medical attention. Separate and detailed data collection systems do not exist in other areas such as domestic abuse and rape. Let’s stop sensationalist headlines. Let’s recognise the limitations of this uninterpretable data collection and question whether the wider cost can be justified; and push for better data rather than peddle propaganda. Failure to do so risks setting back the many commendable efforts to tackle FGM in the UK.
Dr Brenda Kelly
Consultant obstetrician, Director of Oxford Rose (specialist FGM) Clinic, John Radcliffe Hospital, Oxford

• As a midwife and founder of the Female Genital Mutilation Clinical Group, I read with interest the response from Professor Alison Macfarlane. Professor Macfarlane correctly draws attention to the misleading wording from the report on Health and Social Care Information Centre’s statistics (First annual FGM statistics show 5,700 new cases across England, 22 July) that should have said 5,700 newly recorded cases of women and girls with FGM. But that is still 5,700 newly recorded cases too many. For the first time, we are starting to record the number of girls and women living in the UK whose lives have been damaged by this abhorrent procedure. The FGM Clinical Group campaigned for the recording of FGM in women and girls living in the UK. FGM is not legal in the UK and, as clinicians, we are trying to support and protect vulnerable women and girls who have had their lives and wellbeing damaged by the procedure. I applaud and support the recording and reporting of FGM as it allows us to start to address the issue. I agree with Professor Macfarlane that we need to be able to plan and commission proper health services and support for women and girls affected by FGM, but we are in danger of missing the point and wasting time if we quibble about the precise numbers and details. It does not matter where or when the woman or girl was mutilated – she needs our help, support and protection now.
Yana Richens
Midwife; co-editor-in-chief, British Journal of Midwifery; co-founder, FGM National Clinical Group

• Join the debate – email guardian.letters@theguardian.com

We need better data on FGM, not propaganda | Letters

Hope for "end of Aids" is disappearing, experts warn

Efforts to combat Aids in Africa are seriously faltering, with drugs beginning to lose their power, the number of infections rising and funding declining, raising the prospect of the epidemic once more spiralling out of control, experts have warned.

The UN has set a target of 2030 for “the end of Aids”, which has been endorsed by donor governments including the US, where the president, Barack Obama, said the end was in sight last month.

Related: Think the Aids epidemic is over? Far from it – it could be getting worse | Sarah Boseley

But the reality on the ground, especially in the developing world, looks very different. Many experts believe that the epidemic will continue to spread and the Aids death toll, still at 1.5 million people a year, could begin to soar again.

Prof Peter Piot, the first executive director of UNAIDS and director of the London School of Hygiene and Tropical Medicine, told the Guardian: “I don’t believe the slogan ‘the end of Aids by 2030’ is realistic and it could be counterproductive. It could suggest that it’s fine, it’s all over and we can move to something else. No. Aids is still one of the biggest killers in the world.”

At the recent International Aids Conference in Durban, South Africa, Bill Gates, a self-proclaimed optimist whose foundation has invested heavily in combatting HIV, warned of trouble ahead.

“If we only do as well as we have been doing, the number of people with HIV will go up even beyond its previous peak,” Gates said. “We have to do an incredible amount to reduce the incidence of the number of people getting the infection. To start writing the story of the end of Aids, new ways of thinking about treatment and prevention are essential.”

Those fighting the epidemic face a devastating combination of problems:

• Every year, around the world, nearly 2 million people, 60% of them girls and young women, become newly infected with the virus, despite prevention efforts.


• In developing countries, HIV is becoming resistant to the drugs used to treat people and keep them well, which means they will increasingly need other drugs that are currently unaffordable.


• Donor countries are cutting back on funding.

Globally, 38 million people are living with HIV, 17 million of whom are now on drugs that stop them transmitting the virus to others. But the rise in infections appears inexorable.

Piot said: “It is as if we’re rowing in a boat with a big hole and we are just trying to take the water out. We’re in a big crisis with this continuing number of infections and that’s not a matter of just doing a few interventions.”

A woman walks past Aids information on the wall of the Redemption hospital in New Kru Town near Monrovia, Liberia. Photograph: Ahmed Jallanzo/EPA

There had been hope that treating people would stop the spread, but studies are beginning to show that “test and treat” – putting people on drugs as soon as they test positive for HIV to prevent them being infectious – may not work. Many people do not want to take medication until they become ill. Piot believes that drugs will not stop Aids and that cultural change, which is far harder to bring about, will be necessary.

“We will not end HIV as an epidemic just by medical means,” he said. “People are not robots. Sex happens in a context. It is about power. Southern African girls and young women are infected by men who are much older than themselves. It’s about poverty. It’s also about a culture of machismo. There are also gay men all over the world who are discriminated against and underground, and there’s no way you can prevent infections if something is underground.”

Gates said the number of young people at risk in Africa is set to rise markedly. In a few decades, 40% of the world’s youth will live on the continent.

Related: It isn’t lack of drugs preventing us eradicating Aids, but inequality | Lilianne Ploumen

“The largest generation in history is entering an age where they are most at risk … In 1990, there were 94 million people between the ages of 15 and 24. Already, that number has doubled. By 2030, [there will be] more than 280 million young people. The vulnerable age group will be three times as large in 2030 as it was back in 1990,” he said.

Drug resistance is only now beginning to be monitored in Africa, but there are clear signs that it is growing. Médecins Sans Frontières has found 10% resistance in its projects.

A report for the World Health Organisation by Michael Jordan of Tufts University in Massachusetts tells of 40% resistance to one of the crucial drugs in the basic cocktail given to people in less economically developed countries. Resistance is widespread in Europe and North America, but people with HIV are moved on to newer drug combinations that are vastly more expensive. The basic regime in Africa costs $ 100 (£75) a year. Drug treatments in the US cost more than $ 20,000 a year.

Jordan’s report shows that more than one-third (35.7%) of nearly 1,200 clinics reported regularly running out of at least one drug over the course of a year. If antiretroviral drugs are not taken consistently, the virus mutates, resistance develops and the drug will no longer work. It also found that one in five patients was lost to followup, so nobody knows whether they are being successfully treated.

Funding for HIV is declining, in response to austerity measures, financial crises and the assumption that the epidemic is under control. A recent report from the Kaiser Family Foundation and UNAIDS said funding from donor governments fell last year for the first time in five years, from $ 8.6bn in 2014 to $ 7.5bn.

Hope for "end of Aids" is disappearing, experts warn

Democrats demand Congress end its vacation to approve Zika funding

Senate Democrats have called for Congress to end its recess and immediately approve emergency funds for combating the Zika virus in America, after Florida reported its first cases of mosquito-borne infections on the mainland, and funding for mosquito nets for pregnant women started running low.

Near downtown Miami, teams of doctors were going door to door on Saturday to alert an estimated 30,000 residents, particularly pregnant women, of the risks of being bitten by local mosquitoes believed to be carrying the virus.

On Friday, Florida governor Rick Scott and the federal Centers for Disease Control and Prevention (CDC) confirmed that four new cases of the disease in the Miami area were almost certainly contracted through local insect bites. CDC director Tom Frieden warned: “Zika is here now.”

Testing of mosquitoes in the area has not produced a positive result for Zika so far, Scott said, but the authorities believe that is the most likely explanation for how the latest infections had occurred.

Florida Senator Bill Nelson and Senate minority leader Harry Reid then demanded that Congress reconvene and release emergency funding, which lawmakers had failed to approve amid bitter infighting. They then left the matter unresolved for a seven-week recess that began in June, coinciding with the start of the peak months for North American mosquitos.

“If there was ever a time for Congress to act it is now,” Nelson wrote in a letter to the majority leader, Republican Mitch McConnell, on Friday, calling on him to reconvene the Senate.

Reid called on both houses of Congress to reconvene. Then he added on Twitter that: “Americans can’t afford to wait until Congress’ vacation is over.”

The vast majority of the more than 1,600 cases of Zika previously reported by the CDC within the US were contracted while patients were traveling abroad or, in a small number of cases, through sexual transmission after entering the US. In the US commonwealth of Puerto Rico, there are thousands of mosquito-borne infections, in what Frieden called a “silent epidemic” that could threaten the mainland.

Dr Aileen Marty was one of more than 80 doctors and health officials going house to house in the affected area in Miami-Dade and Broward counties in Florida on Friday, asking residents questions and offering testing for the virus.

“The goal is to get to every single household in this area and talk to them about eliminating mosquitoes, asking questions, answering questions and if there is a pregnant women in the house, giving her special advice,” she said.

Marty is professor of infectious diseases at Florida International University and has worked as an expert in, among other disciplines, tropical diseases and disaster medicine for the federal government, the US military and international organizations, for instance with the WHO in Nigeria during the Ebola epidemic in 2014.

“We need everyone doing the right thing so we can squish this immediately,” she said.

Marty added that Florida had had success in quickly jumping on local outbreaks of mosquito-borne dengue fever and chikungunya in the past, and she was confident that state and local officials would do the same with Zika.

She said the area where the locally transmitted cases have been found, close to the center of Miami, was “a pretty dense area”.

“It’s an arts district, lots of tourists in the evening, which is of concern to us as well,” she said.

The Zika virus is carried by female mosquitoes of the Aedes species: principally Aedes albopictus and Aedes aegypti, which are active during the day. Together the species have a wide range around the US, as far north as Maine and Minnesota and as far west as northern California.

Marty said the relevant mosquitoes operate within a small radius of around 900 to 1,500ft of where they hatch, though they can be carried on the wind.

“To find Zika in a mosquito is very difficult,” Marty said. “Not finding one does not mean Zika is not there. You have to get really lucky, there are a lot of mosquitoes and most hatch fine, then there will be one family of insects that gets infected.”

She said the Aedes species is “sneaky” and does not bite one person and lays eggs, but takes “little nibbles” out of five or six people in obscure places, “like behind your elbow”, a female lays eggs.

The Florida and federal authorities have warned people in Miami to use mosquito repellent when going outside.

Marty and other doctors in the rapid response teams that have been distributing Zika prevention kits to households, in particular giving mosquito nets to homes where a woman is pregnant or thinks she is pregnant.

“But we may run out of funds on the nets,” she said.

She was unable to provide details of how funding is decided for such resources. “Mosquito nets are being issued,” she said. “They are only being given to families with pregnant women, but the funding might run out for them.”

When asked whether pregnant women she was encountering in the affected area were scared, she said: “Of course they are. Wouldn’t you be? They want to know what their risks are.”

Contracting the Zika virus during pregnancy, especially early on, brings the risk of fetal brain malformation, especially microcephaly.

Marty reassured women in the affected area that action was being taken and their chances of being infected with the Zika virus via local mosquitoes were currently “slim to none”.

A spokeswoman for the governor said details of Zika funds were being handled by Florida’s department of health. A spokeswoman for the department sent a statement to the Guardian, saying: “the Governor has committed $ 26.2m in state funding to preparing for and responding to Zika. We have no shortage of Zika prevention kits.”

The CDC has not recommended that pregnant women leave the Miami area or refrain from traveling to that area.

But Dr Peter Hotez, dean of the National School of Tropical Medicine, at Baylor University in Waco, Texas, disagreed with that assessment.

“In Miami if you are pregnant or you might be pregnant, limit your time outdoors. Use air conditioning and if you are going out, consult your OB-GYN,” he said.

Hotez also warned that during the peak mosquito season of July, August and September, “if you are pregnant or you think you might be pregnant, avoid travel to the Miami area. You now have to treat Miami like Puerto Rico or Brazil or Honduras. That’s my opinion – but CDC is not willing to go that far yet.”

Hotez said the Aedes species is particularly successful in cities, and infected people arriving from the Caribbean and Latin America, especially through ports such as Houston or New Orleans, could be at risk for infection and as hosts for infected eggs.

The CDC has warned of the prospect of Zika outbreaks along the southern, coastal US this summer.

Hotez called Congress’ refusal to approve federal funding “outrageous”.

A compromise bill to provide $ 1.1bn in funding, below the $ 1.9bn that the White House has requested, had been close to approval but was blocked by Senate Democrats after House Republicans returned it with unrelated provisions about abortion restrictions, overturning environmental and health regulations, and scuppering bans on the Confederate flag. Senator Bill Nelson condemned the attachments as “poison pills” that doomed the legislation.

Republican Senator Marco Rubio has broken with his party on the issue, and on Friday tweeted a demand for funding from the Obama administration. His office also released a statement that said he has warned of the risk of local transmission of Zika “for months” and that “sadly that has now become a reality”.

The CDC’s Frieden warned that the US has “an unprecedented health threat”.

But Hotez made a more specific, pointed warning. “There is no margin for error,” he said. “If we start seeing babies with microcephaly seven, eight or nine months from now in Miami that will be unacceptable.”

Democrats demand Congress end its vacation to approve Zika funding

Think the Aids epidemic is over? Far from it – it could be getting worse | Sarah Boseley

Sixteen years ago, an 11-year-old boy and a judge alerted a shocked world to the terrible reality of Aids in Africa, where hospitals were overflowing with the dying and children were orphaned.

Related: Hope for ‘end of Aids’ is disappearing, experts warn

The international Aids conference, held in 2000 in Durban, KwaZulu-Natal – the world’s worst-hit region – was billed as a scientific meeting. It became a week-long, vibrant, impassioned, singing, dancing, drumming and marching mass rally. Scientific neutrality disappeared as researchers became campaigners too.

The cry was for drugs to save lives. It was too late for Nkosi Johnson, the boy who spoke at the opening ceremony. He died the next year. Judge Edwin Cameron stunned his native South Africa by declaring he was gay and HIV positive, and said it was iniquitous that he could buy drugs from Europe or the US to save his own life while his countrymen and women died in their thousands. Nelson Mandela called on the world to act.

Their calls were heard. Campaigners, in collusion with generic drug makers, brought down the price of a three-drug cocktail to suppress the virus and keep people well, the cost dipping from $ 10,000 a year then to $ 100 (£76) today. Last week the conference was back in Durban, with 17 million people on treatment. But it’s not over. Far from it. There is a real possibility that Aids will re-emerge as the mass killer it was at the turn of this century.

It is a complete crisis. The message of the conference is that there is all this hope – and it is not sustainable

Deenan Pillay, virologist

There are about 38 million people with HIV, so more than 20 million are not yet on treatment. About 2 million more get infected every year. Antiretroviral drugs not only keep people well but also stop them being infectious. The World Health Organisation now advises that anyone with HIV should take drugs as quickly as possible, not just for their health but to protect their sexual partners. In September, South Africa will introduce test and treat.

However, this year’s conference heard disturbing news from researchers at the Wellcome-funded Africa Centre for Population Health in KwaZulu-Natal, which has been trialling test and treat in a population where nearly one in three people have HIV. They found that while most people agreed to be tested by health workers visiting their homes, only half of those who were diagnosed with HIV then went to a clinic to get the treatment that would stop them infecting their partners.

Test and treat

A sugar cane farmer gets tested for HIV by an MSF health worker in Gwegwe on the outskirts of Eshowe, 2014. Photograph: Gianluigi Guercia/AFP/Getty Images

In Eshowe, a town of 14,000 people set among rolling hills and sugar plantations, Médecins Sans Frontières has been pioneering testing by health workers who go door to door. MSF has also opened testing booths next to the butcher’s and by the taxi rank, where working men pass by on payday. They have found the same thing as the researchers in KwaZulu-Natal. They can get high proportions of people tested – but not to the clinic to get the drugs.

“We give them referral letters to the clinic. Then you find they don’t go,” says Babongile Luhlongwane, who walks miles every day on rough tracks with her kit in a backpack to reach those who live in this rural community. “Last Monday I had three men who tested positive. Two went to the clinic. The other said he didn’t have time.”

Dr Carlos Arias leads MSF’s initiative to set up monthly clinics on sugar plantations, testing workers for HIV and delivering medication. He says they see people with Aids who have virtually no immune system left.

Related: Village girls fight scourge of the ‘blessers’ – whose gifts ruin their lives

South African guidelines say people should be treated when their CD4 count – a measure of the strength of their immune system – drops below 500. “We see CD4 counts of less than 100 – CD4s of five or six,” he says. A serious infection would kill them. He tells of one man who arrived with a CD4 of 13 but did nothing about it. Two years later he was tested again and had a CD4 of 8. That means the virus in his body will be rampant and he will be highly infectious to a sexual partner. “HIV prevalence here is enormous,” he says. “In KwaZulu-Natal, among women aged 15 to 29, it is 56.8%.”

The Africa Centre trial in northern KwaZulu-Natal compared what happened in 22 clusters of 1,000 people: half were randomly allocated to test and treat, half told they would be given drugs when their CD4 count dropped below 350 (500 when government guidelines later changed). The trial set up a mobile clinic in each of the 22 clusters.

The trial investigated whether immediate treatment led to a drop in the numbers becoming infected. The answer, to their dismay, was no.

“Disappointingly, we found no difference in the number of new infections between these two randomised sets of clusters,” says Deenan Pillay, director of the Africa Centre and professor of virology at University College London.

Sex in the cities was an issue. People were travelling away from home into Durban and Johannesburg a lot more than expected, and having sex there. But more problematic are the social and cultural mores that have long beset HIV response in Africa. Far fewer men went to the clinics for treatment than women. “It is a hierarchical society. It is about being seen to be positive. There is stigma associated with it,” says Pillay.

He has been working with this community for more than 10 years, he says, and saw the huge change when people stopped dying. “Treatment was first used for people who were very ill and dying – and they lived. Now we talk about people who appear well and look well and you are asking them to medicalise themselves, to go to this government clinic where you have to queue up all day and you see other people you know there.”

An MSF mobile clinic to test people for HIV in Ngudwini, on the outskirts of Eshowe, 2014. Photograph: Gianluigi Guercia/AFP/Getty Images

Pillay thinks more must be done to target the sugar daddies or “blessers” – the older, working men who give gifts and money to impoverished young girls in exchange for sex. About 60% of new cases are women. “It is horrendous. In our setting, a 15-year-old girl today has an 80% chance of being infected in her lifetime,” he says. At antenatal clinics where pregnant women are all tested for HIV, half are positive.

The government has launched a campaign telling young girls not to sleep with older men. But, says Pillay, “the real problem is the men who are not being tested and treated”.

“It is a complete crisis. The message of the conference is that there is all this hope – and it is not sustainable.”

Cost is a huge and growing issue. If test and treat worked, it would slash the bills by preventing new infections. But that assumption now seems premature and funding from donors has dropped for the first time. A report by the Kaiser Family Foundation and UNAids says they gave $ 7.5bn last year, compared with $ 8.6bn in 2014.

The drugs bill is going to rise dramatically, not just because of the increase in infections and the fact that everybody must take antiretroviral therapy for life, but also because resistance is spreading to the basic three-drug combination available in Africa for as little as $ 100 a year. Hospital beds are once more taken up by Aids patients whose treatment has failed. Africa cannot afford the newer drugs available in Europe and the US.

MSF has found resistance levels to the basic combination of 10% in its South Africa projects. There has been worse news in other parts of Africa. A study covering Kenya, Malawi and Mozambique found 30% of people on second-line treatment, which costs at least $ 300, were resistant. The lowest cost of a third-line drug regime – or salvage therapy – in Africa is $ 1,859 a person annually.

“I think we are seeing the tip of the iceberg,” says Dr Vivian Cox of MSF. “A lot of countries are not doing routine viral load monitoring in the first place. They are moving towards it and then you can imagine what they will find.”

Youth focus

Related: Under the shadow of ‘dirty’ HIV, South African children offered a refuge

Nobody at this year’s conference was talking about the end of Aids, as they were only four years ago when the conference was held in Washington DC. Bill Gates expressed real concern. If it is difficult now to treat and prevent HIV infections, he said, the demographic bulge could make things worse.

“If we only do as well as we have been doing, the number of people with HIV will go up even beyond its previous peak,” Gates said. “We have to do an incredible amount to reduce the incidence of the number of people getting the infection. To start writing the story of the end of Aids, new ways of thinking about treatment and prevention are essential.”

A vaccine is still a long way off. Pre-exposure prophylaxis works for the partners of people with HIV in the global north. Taking an antiretroviral drug guards them against infection. But that looks very hard to implement for young women in Africa who barely own their own bodies and could face accusations of either having HIV or being a prostitute.

There are brave attempts to change behaviour and the subservience of women and girls. Actor Charlize Theron is funding projects to educate, help and support young people. MTV’s Staying Alive Foundation is attempting to reach young people through its mass media campaign Shuga, sharing the sexual lives of more affluent young Africans. After two series in Kenya and two in Nigeria, the fifth will be filmed in South Africa.

Surveys carried out in South African schools to determine the issues facing 14- to 20-year-olds before the new series offer a glimpse of the dangers they face. A third of girls said a girl does not have the right to ask a boy to stop kissing her. A quarter of the boys said they had “sexually forced” someone. A fifth of the girls said they were sexually active and most of those had been forced into sexual activity at some point.

Charlize Theron visits a project to create youth ambassadors in KwaZulu-Natal in 2013. Photograph: Justin Barlow/Getty Images/The Global Fund

“The figures point to 86% of sexually active girls experiencing being sexually forced by their boyfriends,” say the researchers. “These figures … reflect a need to understand what is going on within heterosexual relationships and the experience and position of risk within those relationships. It also calls for HIV prevention efforts to help build safe and supportive norms within relationships.”

Of the girls among the 3,000 students surveyed in three provinces over two years, 15% said they had been pregnant – which equates to 70% saying they are sexually active. Nearly half the young people – 46% – said a young couple who went public about one of them becoming HIV positive would be openly judged and 4% thought they would be physically harmed. “This indicates the fear-filled environment South African young people are still growing up in when it comes to HIV,” says the report. “Fear keeps people silent and silence feeds everyone’s risk for HIV and for not getting the care and support they require to address HIV infection.”

Research is showing that Shuga does have an impact on young people’s behaviour. “Where we see behaviour change work really well is when the audience see their own lives reflected in the storylines,” says Georgia Arnold, executive director of the MTV Staying Alive Foundation, who says she wants to get a DVD to every one of the 6 million high school students in South Africa.

“We’ve had a recent World Bank study that was done on … series four in Nigeria. It was a random, cluster study of 5,000 young people and what it proved was that if you watched MTV Shuga you are twice as likely to get tested for HIV.”

The biggest challenge in fighting HIV is stopping people becoming infected. Photograph: Steve Forrest/International Aids Society

Behaviour change could stop the epidemic – although it is not doing so in Europe or the US – and initiatives could help improve young people’s lives. But it is difficult and slow. Aids will be with us for far longer than anybody used to imagine.

Professor Peter Piot, the first head of UNAids and director of the London School of Hygiene & Tropical Medicine, says the biggest challenge is keeping people from being infected. “It is as if we’re rowing in a boat with a big hole and we are just trying to take the water out. We’re in a big crisis with this continuing number of infections and that’s not a matter of just doing a few interventions.

“We will not end HIV as an epidemic just by medical means. People are not robots. Sex happens in a context. It is about power. Southern African girls and young women are infected by men who are much older than themselves. It’s about poverty. It’s also about a culture of machismo. There are also gay men all over the world who are discriminated against and underground, and there’s no way you can prevent infections if something is underground.”

He believes that it was a mistake to foresee the end of the epidemic a few years ago. “I don’t believe the slogan ‘the end of Aids by 2030’ is realistic and it could be counter-productive. It could suggest that it’s fine, it’s all over and we can move to something else. No. Aids is still one of the biggest killers in the world.”

Think the Aids epidemic is over? Far from it – it could be getting worse | Sarah Boseley

Divorce continues to take a psychological toll on kids

In the early 1920s, a list of exceptionally bright children was assembled for a study about growing up as a genius. These individuals affectionately became known to psychologists, affectionately, as the “termites”, after the Stanford researcher – Professor Frederick Terman – who began the study. The termites completed many surveys over their lifetimes, and the vast majority of the group have now died.

Their death certificates reveal that those whose parents divorced before their 21st birthday lived four years fewer than those whose parents stayed together until at least that point. Male termites typically lived to 76 as opposed to 80; female termites made it to about 82, instead of 86.

Although this group was a bit different to the rest of us – they each scored a minimum of 135 in high school IQ tests – brains and possible dweebish tendencies don’t appear to have exacerbated the impact of parental divorce. Overall, the termites handled life no better or worse than the US population as a whole. They committed suicide, developed alcoholism and themselves got divorced at the national rates.

Related: Divorced by 30: why do so many young marriages come to an early end?

So if parental divorce reduced longevity among the termites, it suggested worrying things about how divorce might affect all kids in the long run. The research subjects’ early deaths were pinned on higher rates of smoking, perhaps indicating a greater lifelong psychological stress following parental divorce.

But is this finding relevant today?After all, the termites experienced their parents splitting up during a period when divorce was much less common and much more stigmatized than it is now. Moreover, since that time, the reasons for divorce and the profile of couples most likely to divorce have changed in all manner of ways. So it seems reasonable to expect that whatever may have led these termites to feel stress more intensely than the other termites is no longer part and parcel of watching your parents split.

Researchers have a lot of disagreements about divorce trends. Most agree that divorce is less common today due to a rise in the age at which people first marry. But some experts believe that divorce rates in the US reached a peak among couples who married in the 1970s, and ever since the 1980s marriages have been more enduring. Other researchers, working with a different set of surveys, counter that the drop-off in divorce in recent decades has been overstated. In their view, divorce seems to have declined among younger couples, but it doubled in the two decades before 2008 among people over 35.

Divorce used to be the preserve of the upper classes. But as it has become legally less onerous, and its financial and social costs have been reduced, lower class couples have composed an ever greater share of divorcees.

Similarly, a highly educated wife used to be linked to greater odds of divorce, but that pattern has at least weakened in European countries taken together, and reversed in the most developed ones. In the US, too, women with a college degree are today far less likely to divorce than women who haven’t surpassed a high school degree. College educated women are also happier in their marriages and with their family life.

But what do these patterns have to do with how much divorce affects kids later in life? To answer that question requires comparing divorce trends to divorcees’ kids’ outcomes over time – outcomes that can reveal their levels of stress and how they have responded to stress as they have matured.

Various studies attempt this, but none over as long a period as an analysis of Swedish children. Astonishingly, Swedish records allow for comparison of people born more than a century apart, since face-to-face interviews using the same set of questions have been posed to Swedes born from 1892 onwards. Interviewees have been asked about their living arrangements growing up, about the extent of parental discord that they recall, and all about their mental health issues into adulthood, from insomnia to depression.

Many divorce trends over the 20th century suggest that children, on average, should have experienced noticeably less distress over time from their parents’ marriage ending. As divorce has become more common, it has become more socially acceptable. Female employment has risen and the welfare state has grown, meaning that single mothers are comparatively more able to provide for their offspring today than in the past. Custody arrangements have also changed, and children whose parents divorced in recent years are more likely than ever to maintain relationships with both parents.

But shockingly, divorcees’ kids in Sweden have seen no improvements in their relative educational attainment and psychological wellbeing. To this day, they are worse off by these measures than kids whose parents stay together. (And Sweden is, of course, a country with a far more generous welfare state and more liberal attitudes than most.)

The ongoing gap in educational performance appears to be due to families of a lower economic class becoming more prone to splitting up over the decades. Kids born into lower income families have always tended to do worse at school, so that trend isn’t due to divorce per se.

But the stubbornly lower psychological wellbeing of Swedish divorcees’ kids can’t be pinned entirely on income. Socioeconomics may explain part of it, but, instead, lots of family arguments appear to leave long term traces.

In short, the impacts of parental divorce are often subtle and long lasting. From the Stanford geniuses to Swedes born in the 1990s, the evidence suggests that kids whose parents have or are about to split up need more support than we realize.

Divorce continues to take a psychological toll on kids

Struggling to understand killers | Daniel Glaser

After last week’s wave of tragic attacks in Germany, Boris Johnson was criticised for publicly speculating that Islamist extremism was behind the shooting in Munich.

While our new foreign secretary’s comments may have been inappropriate – and wrong – his brain, like most people’s, was subject to an overwhelming impulse to find a possible motivation for an action as soon as it occurs.

Our desire to understand the motivations of a killer involves a particular part of the brain called the ‘temporo-parietal junction’. Also known as the ‘mindreading’ area of the brain, it automatically ascribes possible incentives, beliefs and desires to others.

This reflex developed to help us socialise, but is so powerful that we also apply it to inanimate objects such as computers, shouting, ‘Why are you doing this to me?’ as they crash yet again. Even a pair of triangles can appear to exhibit personal motivations, as proved by a psychological test called the Heider-Simmel animation.

However, while Boris’s brain is partly to blame for his speculations, unfortunately it couldn’t help him keep them to himself.

Dr Daniel Glaser is director of Science Gallery at King’s College London

Struggling to understand killers | Daniel Glaser

Airport drinks ban? What a joyless prospect | Barbara Ellen

At first glance, the proposed crackdown on the sale and consumption of alcohol in British airports seems a no-brainer. Why should airport staff or plane crew be forced to deal with abusive or violent passengers? In an era of critical security issues, why should police time be wasted on inebriates? Does it enhance the journey when people have alcohol-fuelled “disagreements” in their seats or someone vomits into their cupped hands on take-off?

On this note, I’d like to apologise for my past misbehaviour. In retrospect, it was a bad idea to ask the airport bar guy for a Jack Daniel’s with the mixer of… two more Jack Daniel’s. To decant vodka into an Evian bottle as a precaution against flight attendants ignoring us. To spend transatlantic red-eyes ranting drunkenly about relationship disasters (that were never my fault, oh no!).

And while there’s a tendency to look back on the time when you were allowed to drink and smoke on planes as a study in Mad Men-style elegance, I belatedly accept that this bears little resemblance to what usually happened: over-ordering drinks, lighting up duty-free fags so often that your seat resembled a hazy micro-climate, rising from said seat with as much plastered dignity as you could muster to weave to the loos, occasionally clutching sleeping strangers’ heads for balancing purposes, sometimes falling on to sleeping strangers, and so on…

Irritating, right? Who’d want to sit next to that? Not me, not any more, but that’s the point – my misbehaviour mainly occurred back in my music hack/“rock chick” days. I’m older now, officially no fun any more, firmly at the “tut, tut, I judge you” stage of the human life cycle.

But just because I’m resolutely past it where alcohol and flying is concerned, does this mean that everyone else has to fall in line? Moreover, are we all supposed to pretend not to notice the unlovely whiff of class contempt swirling around this planned curbing of public hedonism?

To my mind, this proposed legislation seems largely aimed at youthful and/or working-class travellers, with an unexpressed but palpable nod to wayward hen parties, disorderly stag outings, raucous festivals or the kind of package deals that offer two weeks of all-inclusive, unbridled misbehaviour in the sun with your post-Brexit depleted euros.

One can more readily endorse other restrictions on drinking. These proposals came in the same week that a Latvian Air Baltic pilot was sentenced to six months in jail for attempting to fly while seven times over the legal limit. Which, I read, is a very rare occurrence, though “rare” doesn’t sound that soothing when planeloads of passengers are involved.

Elsewhere, there’s a study reporting a rise in middle-class people taking class A drugs such as cocaine and ecstasy and a drop in working-class people doing it. Which raises interesting issues – sometimes perhaps it’s not about the illegality of what you consume, rather the setting in which you do it and whether you’re a public nuisance.

But is this yet more class-based hypocrisy, with an element of the “right” and “wrong” kinds of hedonism? I couldn’t care less if middle-class people perk up their dull dinner parties with a bit of toot. However, I do feel that this quasi-acceptable brand of “sophisticated” illegality could bear contrasting with legal drinkers in airports, most of whom, remember, don’t cause trouble.

Isn’t this what’s going on here – proposed legislation that affects everybody, but is actually an attempt to target and control people who have been outrageously pre-branded as “out-of-control lairy proles”? I repeat, it’s never right for airport staff, flight crew or anyone else to be drunkenly abused or attacked.

However, that’s a totally separate issue to people merely drinking. Most manage to do so without committing any criminal or antisocial acts or even being as profoundly irritating as I used to be.

Let’s do it, let’s put Victoria Wood on a pedestal

Victoria Wood: deserving of a statue. Photograph: ITV

Victoria Wood’s brother, Chris Foote Wood, is proposing a statue of the comedy genius, who died in April, in her home town of Bury. He envisages it in the style of the Eric Morecambe statue on Morecambe promenade, featuring Wood at her piano or in her mac and beret.

While there’s dark talk of crowdfunding, I hope that Bury council is able to stump up for this. I was going to ask of whom Bury could possibly be prouder. As it happens, Bury has been fairly stuffed with notable people, including Robert Peel, who already has a statue, Danny Boyle, Dodie Smith and footballers Gary and Phil Neville.

However, Wood occupies a cherished place in the communal British heart. As with that other recent devastating loss – Caroline Aherne – Wood was an ordinary woman who proved to be extraordinary; even as her talent took her to great heights and new places, she still managed to remain true to her roots.

Personally, I’d be satisfied only if Bury immortalised the entire Acorn Antiques cast in the town square, but never mind me. Whatever form the statue takes, come on, Bury, let’s do it.

Walking back to happiness? It’s easy

Walking: easy, quiet and enjoyable. Photograph: Alamy Stock Photo

The health secretary, Jeremy Hunt, has expressed concern about a study that says that average walking levels have fallen by more than a third in the past three decades. Hunt sports a Fitbit to track his steps, though sadly it’s proving inefficient at monitoring the calories burned while grovelling to Theresa May to keep his job.

The slide in how much we walk is an issue that goes beyond health. On top of my sedentary job, I’d classify myself as fairly bone idle – I’m often surprised not to find a thick web forming between myself, the sofa and the television.

However, I don’t drive (too stupid to learn), so I’ve always walked pretty much everywhere, whatever the weather, within manageable distances, and I’ve made my children do the same.

Some people are amazed that I’m happy to plod about like this. I, in turn, am astonished by some of their short car journeys as well as the way that hordes of commuters are happy to stand waiting for a bus that is nearing the end of its route.

While I’ve been the grateful recipient of many a lift, I find this bus-behaviour mystifying. If you can walk, why not do it? Why would anybody choose a rammed bus over the blessed autonomy of their own two feet?

Some people need to realise that those long flesh-and-bone things hanging from their torsos are there for a reason, other than as a place to hang their jeans and display their shoes. With all the exhibitionist displays of public fitness going on (cycling, jogging), it seems strange and sad that the easiest, quietest, most enjoyable form of exercise of all could be grinding to a halt.

• Comments will be opened later today

Airport drinks ban? What a joyless prospect | Barbara Ellen

"Ayahuasca is changing global environmental consciousness"

Ayahuasca, as it has come to be known internationally, is a plant medicine that has been used in the Amazon for centuries for healing and spiritual purposes. Renowned for the often extraordinary visions it induces – not to mention the deep vomiting – it is made from an Amazonian vine known to western science as Banisteriopsis caapi and usually at least one other plant.

Over the last 25 years or so ayahuasca has gone global, with many 1000s of people travelling to Peru and other South American countries to drink it, and expert healers – curanderos, shamans, ayahuasqueros, maestros – travelling abroad to hold ceremonies. Many drink ayahuasca because they’re looking for healing, some are just curious, some mistake it for a recreational “drug.”

One of ayahuasca’s pioneer scientific researchers is Dennis McKenna, a US ethnopharmacologist and younger brother of the legendary ethnobotanist and author Terence. Some years ago, in an article titled “Ayahuasca and Human Destiny” published in the Journal of Psychoactive Drugs, McKenna emphasised the contribution ayahuasca can make to physical and spiritual healing – “if it is ever afforded its rightful place in medical practice” – and addressing potential environmental catastrophe.

“[Ayahuasca is] the conduit to a body of profoundly ancient genetic and evolutionary wisdom that has long abided in the cosmologies of the indigenous peoples of the Amazon who have guarded and protected this knowledge for millennia, who learned long ago that the human role is not to be the master of nature, but its stewards,” McKenna wrote. “Our destiny, if we are to survive, is to nurture nature and to learn from it how to nurture ourselves and our fellow beings. This is the lesson that we can learn from ayahuasca, if only we pay attention.”

Below are edited excerpts from an interview between McKenna, in the US, and the Guardian, in Iquitos, a city in Peru’s Amazon which the scientist calls the “epicentre” of the “global ayahuasca movement”:

DM: What can [ayahuasca] do for the environmental movement? I think a lot of people, especially if they come to South America, come away with a really renewed appreciation for our connection to and the importance of nature. I think that ayahuasca is a catalytic influence in changing global environmental consciousness, which is something that’s got to happen if we’re going to get out of the mess we’re in. The main challenge we have as a species is – getting on the soap-box for a minute – we have forgotten our connection to nature. We’ve come to the conclusion that we own nature, it exists for us to exploit, and we’re busy doing that. We’re destroying it in the process. We’re destabilising all of these global mechanisms that keep the biosphere habitable by life. I think ayahuasca is waking up a lot of people and reminding them that, “No, that’s not the way it is. You monkeys are not running the show. The plants are running the show, by sustaining life on earth, if nothing else.” There needs to be a global shift of consciousness. People need to understand this before they can really begin to change, and so in that sense I think ayahuasca is an ambassador from the community of species. The message is basically, “Wake up, you monkeys! You’re wrecking the place!” It’s very important and interesting that so many people come away with this strong message that they’ve really been moved and touched by something that they feel is an intelligent entity – an intelligent representative of the natural world.

Sina Ramirez Rios, a Shipibo curandero singing to ayahuasca before a ceremony near Pucallpa in Peru’s Amazon. Photograph: Emilie Lescale

DH: Why is that? Why does it make clear to people our connection to nature? How does it do that? Because it teaches us that the plants and trees are alive, in a sense, and are intelligent and sentient?

DM: I don’t think there is a scientific answer. It’s more like a philosophical answer, or a spiritual answer. This is the challenge of our time: we have separated ourselves from nature and we really need to re-understand that relationship, and as part of the community of species, which we are – we may deny it, we may forget it, but we are part of the community of species. And I think that the community of species is concerned about this problematic primate that they have let loose on the planet. As a species, we are simultaneously the most dangerous thing that has appeared in the course of evolutionary time and we’re also the most promising. Indigenous people have this perspective that [ayahuasca and other plants] are teachers. They exist to give us guidance and wisdom – and I believe that, actually. [Indigenous people] have been the stewards of the plants, the stewards of this knowledge, but I think that now things are getting desperate on a global scale in terms of the environmental catastrophes that are looming. I think there’s a sense in the community of species we’ve got to step up the game and these are their tools to contact human beings and basically say, “Pay attention because you need to re-understand your relationship to nature”, and once that’s understood then you have to start making changes. I think one of the challenges of our species – one of our problems – is that we’re very, very clever. We can do amazing things with our big brains and our opposable thumbs and our ability to use and create technology. No doubt that we’re clever. The problem is we’re not wise – and that’s the whole thing. I think the message from ayahuasca and all these other teacher plants is, “Wise up.” Literally: “Get wise.” So that we can use the technologies we’ve invented in a way that supports and sustains life, rather than threatens life. That’s really the message. It’s a profound message, but it’s a simple one.

The Banisteriopsis caapi vine, the key ingredient to ayahuasca, known by numerous different names throughout the Amazon. Photograph: Emilie Lescale

DH: Do you feel Peru is the centre of what you call the “global ayahuasca movement”, or is it more Brazil?

DM: I think it’s Peru. In terms of its interfacing with the West, or Western culture, in Brazil, where you find it is through churches [like the Uniao do Vegetal], which have adopted ayahuasca as their sacrament. I don’t think there’s a big ayahuasca tourism industry in Brazil. It may be happening, but Iquitos is definitely the epicentre. People have been coming there regularly since about 1995 and it has grown a lot.

DH: Do you think more clinical studies [on ayahuasca] need to be done? That that would be positive for ayahuasca in general?

DM: I don’t need clinical studies to convince me ayahuasca is good medicine, that it’s helping people, but you can publish them [and it’s] a good way to convince skeptical colleagues in biomedicine, rather than just some guy raving about how great it is. . . This also grades over into some ethical issues. There are multiple ones. This is something that exists in the context of traditional medicine. It has already, in a certain way, been co-opted by the West through the ayahuasca tourism phenomenon and so on. Is it ethical to try and take a medicine like this and stuff it into a biomedical research structure? Is that the right way to approach it? I’m not saying that it is and I’m not saying that it isn’t. I just think that we have to be clear that there are aspects here of taking something out of its traditional context. Can it be used that effectively in biomedicine, or do you need the ceremonial ambience? It goes back to these hoary principles of setting. Which are very important. Does it have to be traditional? I don’t think so, but you could say, “Well, why not?” Because this is a Peruvian patrimony. Peru has declared ayahuasca a national patrimony, and you could say, “Well, if you’re going to develop therapeutic protocols and programs around ayahuasca, why not do them in Peru?” You’re not taking it away from anybody. You’re actually creating opportunities for Peruvian doctors, scientists and curanderos to work together to develop therapies that can help people – essentially taking a page out of the idea of medical tourism. Tourists are going to come to take ayahuasca for psycho-spiritual reasons. Why can’t they come and take it for medical reasons? That’s just an idea.

Miguel Ochavano Uquia, a Shipibo maestro working with ayahuasca at the Temple of the Way of Light near Iquitos in Peru’s Amazon. Photograph: Temple of the Way of Light

DH: “Medical tourism.” Have you heard that term used by anyone else [regarding ayahuasca]?

DM: Medical tourism is kind of a buzz word now, especially in the States because of the crazy cost structure of so many medical procedures. . . Ayahuasca therapy is not something you can get [here], at least, not legally, so if you want to access it you can go to South America. In that sense it’s medical tourism. . . I think the ayahuasca tourism thing is definitely a two-edged sword. It’s having a lot of negative impacts on indigenous communities, but at the same time it’s benefitting a lot of people and, in some ways, keeping the tradition alive. But it’s also changing that tradition, as people start to cater to Western tastes and needs. So what needs to develop, I think, is some kind of a fusion of traditional and medical practices that takes the best from both and creates some kind of new paradigm. I hope that’s where it goes.

DH: What you said there about negative impacts on indigenous communities. . . What kind of impacts?

DM: There are multiple ones, but a lot is related to economics: the foreign tourists come to a place like Iquitos with their pockets full of money and their values and their interests and it can completely skew the economic situation. . . [But] it can also be good. Economic influx in communities can be a good thing if it’s properly done. Another aspect is that most of the centres [offering ayahuasca] around Iquitos aren’t owned by Peruvians. They’re owned by foreigners. That’s fine. They’re the ones that have the resources to set these things up, but then there’s a temptation to not treat their people well, not compensate them well, and then there’s the issue that you get in any kind of cult-like situation where you have a very powerful medicine, you have people coming in to have these experiences, often they’re put in a vulnerable situation because the whole point of the exercise is to go to a place where you can open up and examine your deepest, darkest fears and secrets and so on. If you happen to be with a curandero who doesn’t necessarily have your best interests in mind – there are plenty of those – you can be mistreated. As you know, sexual abuse of foreign tourists in ayahuasca centres is not uncommon. Ayahuasca, like anything else, is a technology. It’s a tool. It really doesn’t have any inherent moral qualities. It can be used in really positive ways and really negative ways because the ethics of it originate in the people who use it and how they use it and what they use it for.

Ayahuasca being prepared near Pucallpa in Peru’s Amazon. Photograph: Emilie Lescale

DH: Just to pull back a second. If asked, “Are plants intelligent”, would your answer to that be, “Well, obviously, ayahuasca is a good example”?

DM: Yes, ayahuasca is intelligent. Yes, plants are intelligent. Not in the way that we are, but in some ways they’re much smarter than we are. It depends on how you want to define intelligence, right? If intelligence doesn’t require nervous systems, it it doesn’t require brains. . . if intelligence is when something reacts to their environment in a way that optimises its adaptation. Under that rubric plants are definitely intelligent – but not like we are. They don’t have brains and they work on different time-scales. This is part of a co-evolution we’re seeing. Co-evolution works on vast time-scales and ayahuasca has only been known to the West for less than 150 years. That’s a tiny slice of historical time. . . I think we’re only beginning to learn how to use ayahuasca, how we use it as a tool to wake up other people because, if you haven’t noticed, there’s a great deal of willful ignorance, at least, in the States, particularly with regard to environmental issues. Our politicians – at least, the Republican side of the equation – are proud of the fact they don’t know anything about climate science and they deny that it is even important. This is the attitude that needs to be changed. Stupidity is not going to solve our problems and yet they’re behaving as though it will. . . Are you familiar with the author Michael Pollan?

DH: Yes. Food Rules [the title of a book by Pollan].

DM: He wrote a wonderful article in The New Yorker. The Intelligent Plant. I think it really well summarises some of the issues right now that science is looking at, in terms of plant intelligence. I mean, a few years ago, you bring that up, you’d just be laughed at. Now, not so much. There’s really compelling evidence that plants are capable of planning, remembering, dealing with other plants and other things. . . Something else we’re learning about intelligence: you don’t have to have a brain. Brains are over-rated, you know. What you have to have is neural networks – very extensive networks of connections. If you look at eco-systems, if you look at forests, if you look at things on the macro-scale, these are tremendous, enormous neural networks. You can think of them from that perspective, like the connections between the roots of plants and the fungi in the soil. These are mycelial networks that can sometimes cover many miles. The biggest organisms in the world are actually mushrooms, believe it or not. Not psychedelic ones, as far as we know, but they’re mushrooms that grow in the forests in Oregon, places like this. They’re a cubic mile in extent. They’re 80,000 years old. Because the mushroom part is just the reproductive body. What’s really going on is the mycelial networks in the soil: the hyphae of the fungi is closely associated with the roots of plants, so it’s a very, very close symbiotic association. This is the intelligence of plants. This is the real thing. This is not just a romantic notion. This actually is real. It’s sometimes called the Gaia Hypothesis, originated by James Lovelock, a geophysicist and geochemist. . . His basic idea is that the entire biosphere is regulated, working together in such a way to keep it within these fairly narrow parameters that will support life.

DH: One more thing on plant intelligence. . . There was a book recently published, Brilliant Green, written by an Italian, Stefano Mancuso.

DM: He’s one of the leading researchers on this right now.

DH: I read the book by Mancuso, which really got me thinking. One of the things he doesn’t address is the idea that plants teach humans, that there is that kind of relationship.

DM: It’s a bit of a leap for him, but it is definitely where this is trending.

DH: Are you continuing with your scientific research into ayahuasca at the moment?

DM: Well, not so much, but I’m interested in moving in to the therapeutic area and I would like to do some structured chemical, clinical studies. But I want to do them in Peru. And I organize retreats in the Sacred Valley [in the Cusco region] at Willka T’ika.

DH: Can I just finish with one more question, Dennis? You say in “Human Destiny” [the article published in the Journal of Psychoactive Drugs] “You monkeys only think you’re running things.” And that’s quoted, as if someone else said it. Is that what your brother Terence said, or is that what you said at some point?

DM: It’s what the ayahuasca said.

DH: To who?

DM: Me.

DH: Ok. And what does it mean? Is the play on “You monkeys only think you’re running things?” or am I reading too much into it?

DM: When I took ayahuasca with the Uniao do Vegetal for the first time, in Sao Paulo in 1991, I had a very impactful ayahuasca experience in which I was shown photosynthesis at the molecular level. Being a plant biochemist I sort of understand these processes. It was extremely inspiring to me at the time. The take-home lesson was, “You monkeys only think you’re running the show.” It’s in my book [The Brotherhood of the Screaming Abyss].

"Ayahuasca is changing global environmental consciousness"