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An illustrated, coffee-table edition of the Bhagavad Gita sits open atop a wooden stand in the office of Cipla managing director Umang Vohra, at the company’s plush headquarters in Mumbai’s Lower Parel. The cover has an illustration of the famous dialogue between Krishna and Arjuna in a chariot. It captures the setting of the hugely influential scripture, a treatise on dilemmas, decision-making and duty. It’s kept open so that the office’s occupant or visitors can easily browse through it. It’s perhaps an apt item to adorn an office that has seen some difficult decision-making in recent years. Cipla has a familiar problem large corporations everywhere are susceptible to — plateauing performance and the need to ensure that the disruptive forces ahead don’t pull the rug from under its feet. At the pharma giant, there’s the additional complication that the challenge needs to be tackled even as a generational shift is underway at the company. YK Hamied, Indian pharma’s elder statesman and the man who built Cipla into a global generics giant over 52 years ago, stepped down as MD in 2013. His niece Samina Vaziralli is now the promoter group member holding the highest executive office, as vicechairperson, and runs the company along with managing director Vohra. 69179752 Vaziralli took over the job in 2016, the same year Vohra was elevated as MD. The years following Hamied’s departure saw a slew of exits from top management ranks. As they settle into their roles amidst a sense of management overhaul, Vaziralli and Vohra must steer Cipla into a trajectory of steady growth, while ring-fencing it from future shocks. And their principal prescription for the company — greater focus on North America, a market the company had deliberately stayed away from — is fraught with risk. For Vohra, the move from a top role with Dr Reddy’s Labs in the US to Mumbai as Cipla CFO was in parts driven by a desire to be closer to his ageing parents. With revenues hovering around $2 billion and a market cap of Rs 45,000 crore, Cipla’s profit and loss statement is a daunting responsibility to shoulder. His arrival at the company in 2015, in hindsight, was perfectly timed. 69179758 At a time of transition and leadership search, he swiftly moved up the top ranks, becoming COO and CEO in quick succession. The company promoters — the Hamied brothers, YK Hamied and MK Hamied, who control 36% of the company’s equity — had made some difficult choices of their own two decades back. They decided to stay away from the US generics business — a $104 billion market today — and focus on other geographies. The generics business involves reverse-engineering blockbuster drugs that are going offpatent. Now there is an opportunity to change course, and they have placed their trust in Vohra. The question is, can the 84-year-old company, with a strong legacy of affordable generics around the world, accelerate in a new direction even as the ship is just about steadying? It’s a manoeuvre that could make or break the ship. 69179766 The Hamieds of Cipla The league table of Indian pharma companies is led by Sun Pharma, which currently enjoys a market cap a shade above Rs 1 trillion. Then come Dr Reddy’s, Aurobindo Pharma and Cipla, all of which are neck and neck in a band of Rs 45,000-48,500 crore.Cipla’s consolidated quarterly revenues have remained somewhat stable, fluctuating in the Rs 3,400-4,000 crore range for the last 11 quarters. Cipla’s annual dollar revenues have floated around the $2 billion mark, depending on the dollarrupee exchange rate. India has remained central to its strategy, even as India’s share of revenues has fallen marginally from 42% in 2015 to 39% in 2018, while the share of the US market has inched close to 20%. Bulk of the business of Indian pharma companies such as Cipla come from selling generics — chemical copies of proprietary drugs — at home and around the world. 69179774 Prior to 2005, when India signed the TRIPS (Trade-Related Aspects of Intellectual Property Rights) agreement, Indian pharma companies could sell generic versions of drugs with US patents in other markets. Now they sell off-patent drugs in the US and elsewhere. US patents are typically granted for a period of 20 years, to incentivise discovery. But historical patterns have been such that molecule discoveries are now rare and most of the world’s blockbuster drugs, discovered and invented in the period between the 1970s and the 1990s, have now exhausted their patent protection. Major drugs still under patent protection are not more than about a dozen. Cipla chairman YK Hamied, 82, played a major role in blazing the trail for Indian pharma, waging bruising legal battles with global pharma majors for the right to market generic drugs in parts of the world that could have never afforded the proprietary versions. Therefore, depending on who’s doing the talking, he has been variously described as “Robin Hood” and “outspoken buccaneer”. He was once feared for his ability to hurt global pharma majors by bringing down drug prices. For example, in 2001, Hamied stunned the pharma world by providing a cocktail of three drugs — stavudine, lamivudine and nevirapine — used to treat HIV, at $350 for a year’s supply. It was one-thirtieth of the pricing that pharma majors were charging for the three drugs at the time. Everyone was forced to drop prices. Going further back, he was instrumental in getting the restrictive British-era patent laws changed in India in 1972, opening doors for the growth of Indian pharmaceutical industry. Hamied’s approach to business was likely influenced by his parents’ approach to life itself. His father KA Hamied was a Gandhian entrepreneur who wanted to manufacture drugs for India, and his mother Luba Derczanska, a Polish Jew, had strong socialist leanings. 69179781 Cipla was founded in 1935 and YK was born a year later. Hamied senior and Luba had met during a boat ride near Berlin as students. They married later, and had to flee Berlin when the Nazis took over. Luba’s parents were killed in the Holocaust. Umang Vohra recalls a conversation with YK Hamied while taking over as CEO, during which he was given carte blanche to run the company, as long as he thought long term and remembered that Cipla was created to solve problems for patients. Soon after, Vohra sought out MK Hamied, 79, YK’s younger brother who is also on the board and has been in the management along with YK right through. Vohra asked MK Hamied what he felt about missing the US generics bus. Wasn’t it the biggest mistake that Cipla ever made? The younger Hamied had replied that there could be no comparison between missing the US opportunity and going into Africa to save lives and that he was glad that Cipla made that choice. But now it was up to Vohra to turn Cipla into a global player with footprints across the world. Today, Vohra does not interact with the Hamied brothers on a day-to-day basis. In fact the duo, now in non-executive positions, operate from the old Cipla office near the Mumbai Central railway station, while Vohra works out of the plush new Cipla House in Parel. Keeping him company at the top echelons of the firm in the new office is Samina Vaziralli, 42, executive vice-chairperson of Cipla and MK Hamied’s daughter. A former banker with Goldman Sachs in London and New York, Vaziralli is a big part of the transition underway at Cipla, representing promoter oversight. She had taken a break in her career and moved back to Mumbai. Joining the company in 2012, Vaziralli worked in various roles, including head of strategy for the firm. Now Vaziralli and Vohra must do the delicate promotermanagement tango while running the company, giving some taking some, defining turfs and boundaries and developing enduring partnership. far, it is going well, they say. Untitled Carousel 69179939 Vohra knew Vaziralli before joining Cipla, and says she’s an interesting person to work with and has hardly any airs about promoter or an inheritor of a legacy. She is someone, says, “who would still jump into a kaali-peeli taxi”. How’s her professional partnership with Vohra? She says: “I make Umang feel like an owner and he makes me feel accountable, like management.” Vaziralli’s younger brother Kamil had joined Cipla, too, was being groomed for top management roles but instead to become a venture capitalist in London. When Vohra took over as CEO and MD in 2016, Vaziralli was elevated as executive vice-chairperson. Vohra has full operational control and Vaziralli has her say when it comes to acquisitions, capital allocations and manpower. Untitled Carousel 69180023 Baby Steps to a Global Dream It’s been clear for a while now that for Cipla to achieve significant growth, it will need to crack more, sizeable overseas markets. That’s how it embarked on a path of inorganic growth and expansion in the world’s largest generics market — the US. Cipla did its first ever acquisition in 2013 under Vaziralli and former CEO Subhanu Saxena when it bought its front-end partner in South Africa, Cipla Medpro. It acquired two generics players in the US in 2015 that gave it a foothold in that market. It has continued to buy out businesses and ink partnership deals with boutique development companies for specific products that it will fund and market when they are ready. Vohra’s tenure has seen quite a few policy turnarounds, and top management churn. The company has withdrawn from some 40 markets, deciding to focus on the North American geography among developed markets as well as Brazil, China and South Africa among emerging markets. It has exited from a few subsidiaries and sold stake in other areas across the world, from Croatia to South Africa. Cipla also opted out of the push towards biosimilars, deciding it was not its game for now. It even withdrew from a direct-tomarket approach in Europe. Vohra told ET Magazine that he saw no point in playing in smaller markets, or the European market where it had strong competition in its own areas of strength (respiratory, oncology and immunology) from players like GlaxoSmithKline (GSK) and AstraZeneca. Vaziralli explains Cipla’s strategy in the US foray, and says she wants to have three engines of growth in the American market. “I do not want to have a Kodak moment a few years down the line and say that generics are not so hot any more,” she says. So while Cipla is playing the generics game and aiming to file Abbreviated New Drug Application (ANDA) for complex generic drugs every quarter, it is also keeping an eye on new molecules or working on repurposing older molecules in advanced stages of development. When Cipla let go of the US generics business in the past, it also escaped the scrutiny of the US Food and Drugs Administration (FDA) that started a few years back and singed India’s generics pharma industry. The high dependence on Indian revenues has worked as a hedge for Cipla, protecting it while the rest of the Indian pharma majors faced trouble. But all that is changing, and Cipla and its investors will henceforth have to take on the risk of US regulatory action affecting its revenues. In April, Cipla’s US subsidiary InvaGen recalled an injection used to treat low testosterone from the US markets. It had been manufactured in Cipla’s Goa plant. In March, Cipla’s Kurkumbh plant in Pune got 18 observations after an FDA audit. The company has now replied to those. Of the 18 observations, 10 are for a diabetes drug that goes off-patent in 2025. It also raises the biggest question about Cipla’s US push. When Indian pharma companies, with high US revenue dependency, have suffered, running into stringent FDA norms, why is Cipla making a risky bet? The obvious answer is that it is too huge a market for a big generics player to ignore. But that doesn’t dilute regulatory risk in the least bit.Optimal Strategy So has Cipla managed to set the stage for rapid growth, or has the chopping and changing been going on for too long and in too many areas? “Once you dismantle the existing system, it does not auger well for the company. When the management changed, the culture suddenly changed, which has led to stunted growth,” says Shakti Chakraborty, founder of Ergos Life Sciences, and former India head of Lupin, a Cipla competitor. Brokerage firm Motilal Oswal, in its preview of Cipla’s upcoming earnings (third week of May), has said that it expects “modest sales growth from the company’s US business”, but added that it is looking forward to an update on the traction in complex generics launches in US. The India market story, however, has been good for Cipla, and provides a good foundation to base the global journey on. “There is obviously a strategic shift in the company. Cipla was earlier highly focused on domestic market but now they are moving. Vohra and Vaziralli have carved out niche roles between themselves — she looks after overall strategy and he looks after operations. So Vohra has done a good job in this transition,” says Ranjit Shahani, former vice-chairman of Swiss drug maker Novartis. According to figures from All India Organisation Chemists and Druggists (AIOCD), Cipla’s domestic a 9% growth last year, while its peers like reported a 7% growth in domestic business. Jefferies in its February analyst report noted domestic growth accelerated to the highest level 18 months. Cipla has invested back into the India market, especially to expand the reach for its inhalers, the usage of which suffers from social stigma. The company got actor Priyanka Chopra as brand ambassador to promote the use of inhalers for asthma. months after Vohra took up his assignment with Cipla, he learnt that his father, a former navy man, was afflicted with cancer. At that point, his move back to India had started to look like a very good decision, in more ways than one. The family fought the disease for a year and Vohra senior is now in remission. “I was glad I came, because I would not have been at peace, knowing he was going through this while I was somewhere else.” As things stabilise at home, the battle he needs to win abroad will be on high burn. from Economic Times http://bit.ly/2H34lya

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healthandfitnessrecipes-blog · 6 years

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How Sugar Daddies and Vaginal Microbes Created an HIV epidemic

https://healthandfitnessrecipes.com/?p=987

VULINDLELA, South Africa—Mbali N. was just 17 when a well-dressed man in his 30s spotted her. She was at a mall in a nearby town, alone, when he called out. He might have been captivated by her almond eyes and soaring cheekbones. Or he might have just seen her for what she was: young and poor.

She tried to ignore him, she told me, but he followed her. They exchanged numbers. By the time she got home, he had called her. He said he wasn’t married, and she doesn’t know if that was true. They met at a house in a different township; she doesn’t know if it belonged to him. Mbali, who is now 24, also doesn’t know if he had HIV.

She enjoyed spending time with the man during the day, when they would talk and go to the movies. But she didn’t like it when he called at night and demanded to have sex, which happened about six times a month. When she refused him, he beat her. For her trouble, he gave her a cellphone, sweets, and chocolates.

At the time, she had another boyfriend, who was her own age. The older man ordered her to leave the younger boy, and when she refused, he beat her again. Eventually, she grew tired of the abuse and ended the relationship.

Today, Mbali lives with her grandmother in Vulindlela, a verdant rural area near the eastern coast of South Africa, in the humid, hilly province of KwaZulu-Natal. Vulindlela means “open a way” in Zulu, but like many young women here, Mbali faces a lot of closed doors. She graduated high school but didn’t have the money for college, so she spends most of her days helping her grandmother with housework and taking care of her 2-year-old son. I asked if her experience with her “blesser,” as men who initiate transactional relationships are known here, prompted her to warn her friends against dating older men. She let out an exasperated little laugh.

“No!” she said. “They’ll just say I’m so jealous.”

Mbali is HIV negative. But 36 percent of the adults in Vulindlela are positive, as are about 60 percent of the women aged 25 to 40. Although HIV infection rates have stabilized globally, hundreds of thousands of South Africans are infected every year; more than 7 million live with the virus in their bodies. And in the midst of this, the largest HIV epidemic in the world, the HIV prevalence among adolescent girls is roughly five times greater than that of boys. By performing genetic analyses on samples of HIV virus in Vulindlela, researchers have concluded that the high rate of infections here—among both sexes—is driven in part by relationships like the one Mbali had when she was 17.

In a country where two-thirds of people under age 25 are unemployed, some poor South African women and teens date older, wealthier men, who provide them with everything from food to hairpieces to school uniforms. In exchange, the men demand discreet, often condom-free sex. At the same time, many of these young women maintain more egalitarian relationships with boys their own age. Some of the sugar daddies, as these men are also sometimes called, infect the girls with HIV. When those teen girls reach adulthood, they find husbands and pass their HIV onto them. Those husbands, in turn, become the next crop of sugar daddies, infecting the next generation of teen girls and perpetuating the cycle.

This cycle of contagion, researchers are finding, is driven not only by economics and culture but also by the human body’s own microbes. The reproductive tract is home to a delicate balance of bacteria, some of which appear to keep HIV and other viruses at bay. The grooming practices some South African women use to entice wealthy boyfriends might be upsetting this balance, and increasing their risk of HIV infection.

Salim Abdool Karim, the epidemiology professor who is uncovering these connections, has a gray beard and enormous voice. When he was a student, everyone called him Slim, Afrikaans for “clever,” and the name has stuck. He’s of Indian descent, which meant that, under the country’s apartheid-era racial code, he was funneled into the country’s only medical school for nonwhites at the University of Natal, now known as the University of KwaZulu-Natal, in Durban. It’s where he’s worked off and on for more than three decades, and it’s where he and his wife, the epidemiologist Quarraisha Abdool Karim, run the Center for the AIDS Program of Research in South Africa, or CAPRISA. They spend their days trying to figure out why, exactly, South Africans keep dying of a disease that much of the world has nearly forgotten.

In the early ’80s, HIV was still relatively unknown in South Africa. Salim only realized the awful extent of the disease in 1987, when he moved to New York to study public health at Columbia University. It was a terrifying time: Around half a million people in the city had the virus, which was poorly understood. A prostitute who bit a policeman and claimed she had AIDS was walked into the courtroom by officers wearing surgical masks. “You couldn’t escape HIV in New York,” Salim told me in his office one day in February. In New York, it became clear to the Abdool Karims that HIV was about to ravage southern Africa.

He and Quarraisha returned to Durban and zoomed in on a puzzling trend: While many in the United States still viewed HIV as a gay men’s disease, the South Africans with HIV were disproportionately young, heterosexual, and female. Though the disease was still relatively rare, girls were getting HIV five to seven years younger than their male counterparts. That, the Abdool Karims realized, meant young mothers would pass the infection onto their kids. A whole generation of nurses and teachers—the jobs dominated by women—might be wiped out. “Oh, my goodness,” Salim thought. “This is a tragedy on a scale that we have yet to even grapple with.”

Today, the virus kills more than 100,000 South Africans—roughly the population of Green Bay, Wisconsin—each year. While antiretroviral drugs, widely available for free in South Africa, can halt HIV’s erosion of the immune system, there are simply too many South Africans with too high a risk of getting HIV for the country to treat its way out of the problem. Everyone seems to agree: Prevention is key.

In the ’90s, the Abdool Karims began studying different substances that had the potential to prevent HIV infection, especially in women. For the most part, they were a bust: When they tested nonoxynol-9, a spermicide, in a small group of truck-stop sex workers, not only did it have no effect on infection rates, but the substance also inflamed the women’s vaginas, causing burning and itching.

Their progress improved in 2003, when they began testing a drug called tenofovir, which prevents the virus from replicating and seemed to have few side effects. In 2010, Quarraisha presented the findings of their tenofovir gel study at the International AIDS Conference in Vienna: When women applied the gel to their vaginas before and after sex, she reported, the risk of HIV infection dropped by 39 percent. For the first time, women had a way to reduce their risk of HIV infection that didn’t require their partners’ permission. It was a rare glimmer of hope in what had become a dismal field, and the conference attendees rewarded Quarraisha with a standing ovation.

The Abdool Karims were elated and proud. But still, they wondered: Why only 39 percent?

In Vulindlela, women walk alongside dirt roads with babies slung on their backs, and people still answer to the three local amakhosi, or Zulu chiefs. Older people smear red clay on their skin to protect it from the sun. Horses and cows roam the streets freely, and outhouses dot the rolling hills. Today, most people live in small, cinder-block houses, but when CAPRISA first began doing research here in 2001, many still dwelled in traditional mud huts.

In the late 1800s, in KwaZulu-Natal and several other areas, the colonial government imposed a tax on every hut “occupied by a native.” They exempted “houses of European construction” occupied by residents “conforming to civilized usage.” The tax burden forced many Zulus to work in the gold mines, some of which were hundreds of miles away. Miners usually lived in single-sex hostels for much of the year, returning to see their families only every few months. Separated from their wives, the men turned to sex workers, who became vectors of sexually transmitted diseases.

“If you want to create a society in which you wanted a sexually transmitted infection to spread,” Salim said, “you couldn’t do it better than the way in which the colonialists designed South Africa. They designed it to create family instability.”

A woman sits inside her house in Vulindlela, South Africa. (Khaya Ngwenya / The Atlantic)

Though the situation is less extreme now that apartheid has ended, itinerant labor remains common, and many men maintain multiple partners. Men who are able to get good jobs are sought after as patrons and partners by women who aren’t.

Salim and his colleagues wanted to pinpoint exactly who was getting HIV in KwaZulu-Natal, and from whom. In 2014, CAPRISA staff collected blood from the residents of nearly 10,000 households in Vulindlela. They looked at the HIV viruses inside the samples and analyzed each virus’s genes. They identified clusters in which people had passed the virus to one another.

They found that the girls in their teens and early 20s were getting infected by men who were, on average, about nine years older than they were. When they reached their late 20s, these women were infecting partners of their own age, who often didn’t realize it right away. With wandering eyes and high levels of the virus coursing through their blood, some of the men were then infecting the next crop of 16- and 17-year-old girls.

About 40 percent of the men who were passing HIV to younger women had older, female partners at the same time. I wondered aloud to Salim how a society could become so overrun by sugar daddies when the consequences—for women and men—are so severe. What he guessed was this: In many cases, the girls’ parents know about the blessers. “Many of them also support the girl’s family,” he said.

Gethwana Mahlase, a community leader in Vulindlela, told me that the poverty here used to be much worse, and the effects were often fatal. Under apartheid, the country’s rural areas had little infrastructure, and the sick had to be carried to the hospital. In the 1980s and ’90s, some women Mahlase knew had 16 children. They frequently died in childbirth from conditions like high blood pressure, which women in more affluent nations can typically survive with access to medical care.

Economic conditions have improved somewhat, but many people here and across South Africa are still sorely in need of jobs. Among the legacies of apartheid is one of the highest levels of income inequality on earth. On the beach in Durban, the largest city in KwaZulu-Natal, I saw a thin man pick a plastic bag out of a garbage can and lick off its residue—right next to a watchtower advertising the area as the Bay of Plenty. Many kids have no choice but to attend high schools where 60 students might cram into a classroom. Poor and middle-class families often don’t have the means to pay for college and can’t get loans.

“Girls here are happy to have a boyfriend from Johannesburg to take them out of poverty,” Pamela Gumbi, a scientist at the Vulindlela CAPRISA clinic, told me. In the Valley of a Thousand Hills, a community not far from Vulindlela that looks exactly like its bucolic-sounding name, high schoolers told me local girls were dating the region’s big earners: the drivers of minibus taxis.

A woman walks in the Valley of a Thousand Hills. (Khaya Ngwenya / The Atlantic)

The blesser trend shapes men’s lives, too. In a village north of Vulindlela called KwaMsane, I talked with a group of men who were hanging out by a shipping-container snack store in the middle of the day, eating sugarcane as chickens pecked at the grass nearby. A 33-year-old named Zothani bemoaned the lack of local job opportunities, suggesting that leads to some of the sexual practices researchers and policy makers are trying so desperately to change. “The more time we are not working, the more people are giving birth, giving birth,” he said.

Several young men told me that they worry girls won’t want to date them unless they are able to buy them things—a modern anxiety layered on top of the Zulu custom of lobola, in which suitors pay a bride price of several head of cattle.

Others said they don’t mind if their girlfriends have sugar daddies; they think they stand to benefit. “I’m unemployed, so if she has an extra relationship, that money supports me,” said Sanele Ndlovu, a 20-year-old construction worker in Vulindlela, who was speaking hypothetically.

Like a few other men I talked to, Ndlovu is even starting to think he should try to find a sugar mama. The women are doing it, so why not? “There’s nothing wrong with falling in love with an older woman,” he said. “She’s cute, she has no husband, so capitalize on the opportunity.”

Almost as soon as the sugar-daddy trend became widely known in South Africa, it became oversimplified in the media and in popular imagination. There’s a perception, among some here, that the women who seek out sugar daddies are vain and irresponsible. They want nice weaves—considered more fashionable than close-cropped natural hair—and clothes that will look stylish on Instagram, the thinking goes. That makes it easy to blame women for the consequences of promiscuity. “You take a decision to say, ‘I will take off my clothes’—you just can never say it was a mistake,” said the KwaZulu-Natal health minister, Sibongiseni Dhlomo, addressing a tent full of schoolkids in 2016. “Let there be no one who will say they don’t know what happened when they fall pregnant ... Therefore, it is up to you to ensure that does not happen.”

These stereotypes are reinforced by the rise of websites like BlesserFinder, which tries to connect sugar daddies with those hoping to be “blessed.” (BlesserFinder was started by a man, according to news reports.)

My conversations with women who have had transactional sex, or who know those who have, revealed a more complicated picture. For one thing, the women who have blessers aren’t very promiscuous. In CAPRISA’s Vulindlela study, most people had fewer than five sex partners in their lifetimes. The average American Baby Boomer, by comparison, has had 11.

But the sex they are having is very risky. Many of the sugar daddies refuse to wear condoms, saying they “don’t want to waste their money on plastic,” as one teenager put it to me. Women avoid disclosing their HIV statuses to their sugar daddies out of fear they’ll be cut off financially. Since many of the sugar daddies are married, young women meet them at hotels and don’t tell their parents where they are, heightening their vulnerability to violence. In Pretoria, a 15-year-old was recently found dead in a pit latrine after telling her friends she had gone to meet an older man. The suspect, a 33-year-old man, had posted on Facebook that he wanted to find a curvy woman to bless.

The idea that women who have blessers are making bad choices also presumes that there are better choices available. I met A., a pretty, dark-skinned 31-year-old, in a cold, dark exam room of a clinic in Durban. She lives in Umlazi, a large township nearby. She calls it a place for “poor people,” with too many tsotsis—criminals.

A. had a baby at 16 and dropped out of high school. She and the baby’s father broke up because he beat her, she says, pointing to scars on her arms. She now has HIV, and when her mother found out she almost made her go to an inyanga, a traditional healer. She says no one ever told her about condoms. “We are Zulus. We don’t talk about sex,” was the attitude at home, she said.

A. is unemployed. For food, cellphone minutes, and things for her daughter, she turns to a new, older man she’s dating, who she says “treats me well sometimes.” He’s married, and she feels bad when his wife calls to chew her out. “I’m dating this married guy because I get whatever I want,” she says. Meanwhile, she’s also dating a “poor guy, because he’s the love of my life.”

She’s looking for a job as a housekeeper—a profession she likes because sometimes, her employers feed her. “Other jobs you have to bring your own food,” she said, “which is not gonna happen because sometimes we have just sleeping food, and in the morning there’s no food.”

She and the older man, the blesser, don’t use condoms, and she hasn’t told him that she’s HIV positive. Mostly, she’s just hoping to start making her own money soon. “Life is not good for someone who is not employed,” she said. “You sleep, watch TV, sleep, watch TV.”

“Sometimes,” she added, “I don’t live my life.”

At this, her eyes welled up with tears. A nurse standing nearby told me to stop my line of questioning.

Up the coast from Vulindlela, closer to the border with Swaziland, there’s a poor, sleepy town called Mtubatuba. The most happening place to be is a club called the White House, a small cement building with a large outdoor patio. On a recent warm Friday night, a DJ spun Zulu dance music while groups of men and women stood around tables, drinking, dancing in place, and taking selfies.

It could have been college night anywhere on earth. The bouncer told me many girls here come with nothing and expect guys to buy them drinks all night. The girls might go home with the best-looking or most generous of their benefactors. But this, a practice familiar the world over, is not exactly “blessing.”

I approached two 25-year-olds, Nkundu Matha and Thandeka Mathamulo, to ask if women look for blessers here. No, they said, the guys are mainly locals, without blesser-level jobs. If they did meet a blesser, I wondered, how would they react if he asked them to have sex without a condom? “Nice to see you and goodbye,” Mathamulo said.

This attitude might help explain the results of a 2014 study of the area by scientists from Harvard University and the Africa Health Research Institute, who found no evidence that having an older male partner increased the risk of HIV infection.

Even though the blesser phenomenon is real, it seems its effects are uneven, and the country’s HIV epidemic is shaped by other factors, too. Some of them, researchers are finding, are hidden within the women themselves.

In 2010, when the Abdool Karims got their standing ovation in Vienna, they were nevertheless confounded by the fact that the tenofovir gel didn’t fully protect the women from HIV. They decided to investigate whether there was something about a woman’s biology that increases her risk of contracting the virus.

In 2015, CAPRISA released a study in which it measured the cytokines—proteins that serve as markers of inflammation—in the vaginas of 889 women. They found that women who had more of these cytokines, and thus more inflammation, were three times more likely to get HIV over a three-year period. But where was this inflammation coming from? To find out, they sequenced the entire vaginal microbiomes of 120 women.

About 1,300 species of bacteria naturally occur in the vagina. A healthy vagina is dominated by a “good” germ called Lactobacillus, which, under a microscope, looks like a fistful of rod-shaped Mike and Ikes. It scrubs the genital tract with a mild acid and helps keep the “bad” bacteria to a minimum.

Gynecologists, hoping to dissuade their patients from douching, sometimes liken vaginas to self-cleaning ovens. But really, they are more like gardens that—for the most part, and in most women—weed themselves. Sometimes, though, they get overrun by invasive, pernicious flora. And that is where the trouble begins.

Prevotella bivia, it turned out, was the main source of the inflammation that leads to HIV infection. Prevotella is normally found in the gut, but it can migrate into the vagina from the anus. In small numbers, it can be fine. But it can also swarm the place, usurping the Lactobacillus and other healthy bacteria like dandelions taking over a rose garden. On Prevotella’s surface are lipopolysaccharides, which break off and spark inflammation. If a woman happens to get exposed to HIV during a Prevotella inflammation, her risk of infection is much higher.

The CAPRISA scientists decided to test another “bad” bacterium, Gardnerella vaginalis, typically associated with bacterial vaginosis, to see if it had an effect on tenofovir. (Bacterial vaginosis, as many women know, can resemble a yeast infection but must be treated with antibiotics.) Salim’s colleagues added tenofovir to a culture of Gardnerella. Within four hours, about half the tenofovir was gone.

“We were doing these studies and wondering, ‘Why is tenofovir not protecting these women?’” Salim said. “It’s not protecting them because they’ve got Gardnerella, and the Gardnerella is eating up all the tenofovir!”

Today, tenofovir is an integral part of PrEP, or pre-exposure prophylaxis, a pill the South African government has made available for free to sex workers and some university students. Since the pill doesn’t travel through the genital tract, PrEP might avoid being eroded by the vaginal microbiome, but the Abdool Karims and their colleagues aren’t sure yet.

There’s plenty of other evidence, however, that maintaining a healthy, Lactobacillus-dominant vaginal microbiome protects against HIV. One meta-analysis of 23 studies from 2008 found bacterial vaginosis was associated with a 60 percent higher risk of HIV infection. Just last month, the researchers at AHRI found an extraordinarily high rate of bacterial vaginosis—42 percent—among women in the region around Mtubatuba, where HIV is also widespread.

Currently, scientists at CAPRISA and elsewhere are studying what exactly causes Prevotella and Gardnerella to take over the vagina; they have found interesting associations, but no common thread. Women with high levels of Prevotella in their vaginas are more likely to be obese, and black and Hispanic women, regardless of nationality, are more likely to experience bacterial vaginosis. European women are more likely to have Lactobacillus-dominant vaginas than African women are. (Could this be why there’s so much more HIV in Africa than in Europe? Researchers don’t know.)

Semen, too, has a microbiome, and it’s even less studied than its vaginal counterpart. But semen could be causing some of these vaginal disturbances: Semen contains lots of foreign proteins, and women’s bodies become accustomed to those in their regular partner’s semen. But if they are exposed to different proteins, say those in their sugar daddy’s semen, “your body reacts like crazy,” Salim says.

The Depo-Provera shot is the most common form of birth control among poor women here—largely because it’s convenient, and because women with unsupportive partners can hide it from them. The problem, according to the CAPRISA scientists, is that Depo contains high amounts of progestin, which tamps down the levels of estrogen in the body. Because Lactobacillus flourishes in highly estrogenic environments, Depo may open the door to Prevotella and other “bad” bacteria.

Perhaps most damaging to the vaginal microbiome are the practices women use to please their blessers—or even just especially valuable boyfriends. A desirable vagina, many women here believe, is tight and dry. It’s common for women to coax their nether regions into this state by stuffing them with various powders, ashes, and even chewing tobacco.

One study published in 2011 found that women who used “powders, creams, herbs, tablets, sticks, stones, leaves, and traditional products” to dry out or tighten their vaginas were 31 percent more likely to contract HIV. CAPRISA is now conducting a study to see if the increased risk is due to inflammation, vaginal-bacteria disturbances, or both.

Mbali N., left, who once had a blesser, walks with a friend on a path in Vulindlela. (Khaya Ngwenya / The Atlantic)

Before I left CAPRISA, I met with another of its researchers, Sinaye Ngcapu, whose colleagues call him Dr. Healthy Vagina. While Salim and Quarraisha guide all the different facets of CAPRISA’s work, Ngcapu strives to decode the vaginal microbiomes of African women. His goal is to design better HIV-prevention tools—ones that don’t melt away in microbes’ presence.

He grabbed an empty can of Coke Zero on the table to demonstrate why it’s important to understand the microbiome if you want to stop HIV. “If you were to understand how this Coca-Cola is made, you will know how to get rid of the sugar that’s inside it,” he explained.

I paused to ask Ngcapu whether his enthusiasm for the vaginal microbiome ever raises eyebrows—at least among those outside the medical community.

Ngcapu is black, young, and a member of another South African ethnic group, the Xhosa, who live mainly in the country’s south. HIV tore through Xhosa communities, too, and until very recently, apartheid kept people like Ngcapu from acquiring the skills necessary to halt that devastation. To him, this battle is personal.

“It’s scary when you hear that in certain areas, one out of three women is positive,” he said. “As a South African, you have to use South African strategies to answer South African questions. If there will be a cure, it should come here, where HIV is killing our brothers and sisters.”

https://cdn.theatlantic.com/assets/media/img/mt/2018/03/HIVGraphic_Final_01/lead_960.jpg Credits: Original Content Source

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houseinva · 7 years

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For 10 months our fling was absolutely perfect, we didn’t have a single argument, not one. No joke: Ben and I got along so freaking well that in 10 months we didn't have one, single argument that left either of us (apparently) angry. Ben could completely conceal all his emotions, but I also know from future experience just how angry Ben gets when he chooses not to hide his true sentiments, so I think us getting through nearly a year as best friends with benefits speaks to the dynamic we shared.

We got along better than anyone I’d ever been with in my entire life. He couldn’t have seemed happier himself, and I was ecstatic, too.

But Ben and his beau had ended up not breaking up, but they weren’t having sex or getting along either, at least according to Ben. So instead he was always with me, my friends all thought we were together. Ben was growing increasingly angry and hostile towards his boyfriend and his never-ending cheating, too, and it looked like their break-up was once again imminent in the very near future. When Ben spoke of his boyfriend’s lying and cheating, I found it a bit hypocritical. According to Ben, he was cheating on him with random guys here and there all the time; whereas Ben was having an all-out affair with me and spending more time over than he spent at home. Ben only had negative things to say about his boyfriend, though, he vented to me all the time and as a result I never heard anything good mentioned. I never imagined that he actually had feelings of love for him.

Instead I wondered why he even bothered remaining in the relationship, although when I asked he told me something that I wasn’t expecting: “He was the first guy that made the noise in my head go completely silent.” Hmm… that was rather interesting. I asked him about me, and he responded: “You on the other hand are quite the opposite. But I’ve learned to tune out all your noise, Alex, I’ve learned to deal with you quite well, unlike during round 1.”

Regardless of my noise, Ben continued to treat me like royalty. I believed in my heart of hearts he felt really bad for what he’d done to me in round 1: I’d just been intentionally infected with HIV by my ex, he came along and could have been my rock, but instead he treated me like shit and discarded me; that discard was one of the most painful experiences of my life. And all over as stupid word: narcissist.

Ben still was devoted to his boyfriend despite never saying anything positive about the guy – for example, he never missed picking him up after work, although he said that was because he had to stay true to his word. Just like he did with me, me went above and beyond to make sure he was a man of his word and he was accountable to the things he promised others. I found it impressive, it was like he was forcing himself to break out of his nature and stick to doing things for others, he was adamant about being a man of his word. He admitted to me one day that he did have narcissistic “traits,” but claimed that this way of thinking, behaving and living was against his life philosophy and so he chose to live a different path. I believed him; I picked up where my blog had left off and began this, because I was now convinced my blog could have a happy ending. I believed that people with personality issues, narcissism and the like, got a bad rap; that all those negative articles you’d read were one-sided, written by people with bad experiences. You never came across an article actually written by someone with the disorder, you only saw the opposite. So this portion of my story was intended to show the other side, only I didn’t know at all what I was dealing with at that point, that the other side was pure evil and hell fire. Instead I was distracted by the beautiful promises, and all that sex, sex, and more sex.

Only I never once considered that word had maybe enraged him to the point where all this song and dance was merely a way of silencing me for calling him out on his secret. I never once considered this a possibility; with Ben’s never-ending attention, constant sex, incredible compliments, and his offers to help out with everything, what I saw was someone that genuinely wanted to see me succeed and find happiness. He was perfect to me. Only that he did have a boyfriend, and didn’t seem at all phased about dragging me along, subjugating me in a role that was somewhat demeaning. Ironically, Ben’s concern about me isolating myself from the world kinda turned out to be how things ended up for me. But I was clueless as it was happening, little by little, instead I was captivated by his words, overflowing with kindness, and oozing with charm and admiration.

Our feelings became so intense that one night Ben professed his love to me: he said he loved me just as much as his boyfriend, he called me his boyfriend without the title, he swore that if forced him to make an ultimatum, he’d never pick one over the other; must be nice for Ben to have the luxury of so many offers at his disposal. He swore nothing would come in between us, and I believed it. I remember the look in his eyes and the smile on his face when he speaking these words: it felt like the room was growing fuzzy, I felt like he was hypnotizing me to be completely honest; it felt slightly fake even, but it still felt beautiful. And I chose to go along with it, it felt like it was coming from a good place, from his heart, although in hind-site I doubted Ben could truly love to be honest. That was just my gut instinct, whether I wanted to acknowledge it at the time or not…

I was in utter disbelief; I was certain from round 1 that Ben falling for me was not possible, yet somehow the impossible managed to occur. I was shell-shocked, I was perplexed, I was ecstatic.

I’ll admit that I eventually began to take Ben’s “love,” attention, and sexually grooming me for granted; he came over so frequently, the thought of things ending didn’t cross my mind. Our relationship wasn’t just physical sex and talking about love. Ben could find no fault with me, he seemed to be enamored with everything about me, and he made me happy.

Ben never stopped stressing that our friendship was so solid, so important to him, that nothing could ever impact it; time and again he reinforced that nothing – not his current boyfriend, not any future boyfriends – would ever impact what we shared. He was a gentleman, he was glowing light, and he was a master con artist and manipulator, he took pathological lying to a level so advanced that when I became aware of his lies, I didn’t bother questioning him. I can’t put into words the power a narcissist can have over his prey… it’s something that’s not even believable until you actually experience it. I even read up on the disorder while he was courting me, and continued throughout the relationship, only I didn’t believe a word I read as being applicable to Ben. I believed it was a “spectrum” disorder like autism, Ben being only a slight big effected. Or maybe I’d gotten it all wrong I thought, there were soooo many times when I was certain he’d done something horrible to me, only to have him come over with a smile on his face, saying he forgave me for going overboard regarding whatever it was that I accused him of doing. Perhaps I was wrong about Ben having narcissistic ways? Or perhaps the textbooks got it all wrong? Or perhaps the textbook got it right: I would be the one always apologizing, he would be the one always acting like the victim, and every time I’d catch him in the act he’d gaslight me into doubting myself.

When I expressed concern that I could be scapegoated as the cause of Ben and his boyfriend’s problems, suggesting that it might be easier than facing their actual inner demons, he was quick to reinforce that I was incorrect:

Out of any guy I’d met in my life, Ben turned out to be the best one, I felt so lucky to have him in my life, I was so proud to claim him as my bestie. He was so kind, so thoughtful and so good to me; Ben was definitely wild and crazy but yet well-behaved, he was “just right.” He was social when he needed to be, yet still reserved and perfect to be with one-on-one, which I loved. Ben was always so damn mellow and peaceful. I never saw him get upset, at least not yet in round 2. He was always so polite, never rude, never boastful, he was so humble yet he was secure, he was attractive, he was vivacious sexually, he was everything I needed, everything I’d ever wanted, I felt so comfortable with him and I’d never, ever felt this way in my life, not even with my ex during his fake honeymoon phase – this was truly a gift, I’d finally met my match. It was like Ben had been made just for me almost, nobody had ever complimented me this well. As pathetic as this may sound, my experience with round 2 and Ben was the absolute highlight of my life; I’d do anything for that boy, and he knew it, too. I adored him, and I could tell he loved the attention. It was amazing, and I felt like finally – at last – I’d met a true, loving friend that was meant to be.

I always felt safe when I was with Ben. He always left me feeling like nothing bad could happen to me as long as I was with him. I’m not sure why but I knew he always had my back, no matter what.

Despite Ben not speaking highly of his boyfriend, as I mentioned – sexually – he was far more liberal than I was. On several instances, he’d repeatedly asked me to have a threesome with he and his boyfriend, suggesting it was his fantasy, and it might also help re-spark things at home, also. I kinda said yes – although I didn’t really want to, and Ben knew this, too. I’m not portraying myself to be Mary Magdalene, I have nothing against 3-ways – if it floats your boat, more power to you. But for me, personally, while I’d attempted a few in the past, I found that they weren’t my thing. Ben brought up the topic a handful of times, but I managed to always divert the topic elsewhere.

Then one night Ben came by; I was asleep. He woke me up and said, “Come with me, we’re going to my place and having that three-way.” I was lifeless in bed, I was still half-asleep, I told Ben that I had no interest. But he wasn’t taking no for an answer. And suddenly Ben was pulling me out of Bed, grabbing my clothes, and insisting I come with him. I slept during the ride to Ben’s house and went in. What ensued was the worst attempt at a 3way in history; the whole time I clung to Ben like he was my husband, showing little interest towards his boyfriend. It was a flop; I soon fell asleep and Ben eventually dropped me back in my bed. The next day Ben apologized, although he acted like this 3way had been a success when it was nothing but a total failure. I felt embarrassed, I felt lame; but at the same time I’d warned Ben that I was in need of sleep, not sex, so I tried rather hard to get out of this.

In a few days Ben stopped texting every day like he’d always done; when I continued texting like normal, he became short with me. When I tried talking to him by phone he seemed distant and cold, not saying much before hanging up abruptly. Despite these changes, I was blown to smithereens when everything suddenly did a complete 180 in the blink of an eye.

Ben said he needed space, only he was rather abrupt and vague with his words, he didn’t explain anything at all honestly: he just kinda blurted out that he needed a break out of nowhere, and it went straight over my head initially. Ben needing “time off” seemed odd since he did all the making plans, initiating our time together, all the sex, everything was on his time already – I just took whatever he gave – so he already controlled our time together and our space apart. I wasn’t texting more frequently than before, and he was the one that started doing it daily to begin with. It seemed like a double standard and I couldn’t understand why Ben was blaming me for his sudden change in character. He was suddenly not the person I’d just spent 10 perfect, blissful months with.

Just like in round 1, everything came crashing down in a whirlwind of drama, everything I thought was real and truthful, showed itself to be the polar opposite. Here Ben had set the pace for everything, and the moment I started going along at the same exact pace – I didn’t do anything he hadn’t been doing the entire time – he then slammed on the breaks and didn’t give 2 shits about doing this to me. Why all the sudden was he saying he needed space, and a break, and time to focus on… his boyfriend? Wait a second, who’s that, I thought it was… kinda me? HUH? His boyfriend… that guy who was only described in positive words by me, and not Ben? What, what, what?

Just like in round 1, everything erupted unexpectedly, everything I thought was real, was truthful, showed itself to be the polar opposite. Here Ben had set the pace for everything, and the moment I started going along at the same exact pace – I didn’t do anything he hadn’t been doing the entire time – he then slammed on the breaks and didn’t give 2 shits about doing this to me. Why all the sudden was he saying he needed space, and a break, and time to focus on… his boyfriend? Wait a second, who’s that, I thought it was… kinda me? HUH? His boyfriend… that guy who was only described in positive words by me, and not Ben? What, what, what?

I hadn’t gone after Ben at all; I didn’t have any feelings towards him until he brought up being in love with me. I’m not trying to lay the blame all on him, but in all sincerity, this relationship had been his creation.

He was suddenly a different person, he was exactly the opposite of who I thought he was. Here he’d said he had me exactly how he’d wanted me, how he’d envisioned having me all along since round 1. So what the hell was this going on?

Not once did I ask him to give up time with his boyfriend to be with me, that was all his doing. Never once did I ask him to stay when he’d leave my house to go and pick his boyfriend up. I actually gave Ben good advice on his relationship, it was advice that wasn’t aimed at derailing it either, but rather advice on how to keep things on the positive. I was shocked reading his texts, initially I thought he was joking. But then I realized: Ben was flipping the script, he was painting me out to be the aggressor, the one going after a guy that already had a boyfriend, whereas this had been the opposite of what he said. Was he delusional? How could he not be seeing reality? Our entire relationship was Ben’s creation. But I didn’t read Ben’s mind apparently, and failed to realize that despite his harsh words about his boyfriend, that he was still in love, and they were having issues and he needed space apart to deal with them. Yes, he’d asked me to back off but without any other explanation, it was kinda text-shouted among other things, I didn’t get it at first as it was thrown in among other things. He was so hard to read, often what I read him as being I’d later discover was incorrect.

Suddenly he wasn’t at all understanding and kind like he was prior; suddenly everything changed, and I didn’t seem to know the person I was texting, it was someone totally different. Suddenly my perfect Ben wasn’t so perfect after all, he went off on me like a wild animal showing no mercy, no concern for my feelings at all. This was bizarre, this was strange, this was something out of the twilight zone I never foresaw happening only… it was.

Thinking about Ben’s words that summer, and how much they contradicted all he was saying now… it really hurt, I felt betrayed, I felt beyond confused, I felt like I was in the twilight zone. Only I wasn’t; I was at my house, holding my phone in my hand, shaking. And this was actually happening.

I truly believed Ben viewed me as his second boyfriend, I believed in his promises of our friendship lasting forever, but all of this was suddenly meaningless to him, and I was crushed. The boyfriend without the title, me being on the same playing field as his boyfriend, his selflessness, his kindness, his helping me get better, those were all things he said without me ever enticing him to do so.

Could he have done those all to maliciously ensnare me into letting my guard down and letting him take over my mind with lies? He said these remarks all out of his own free will, how could he suddenly flip-flop like this? I assumed he was under stress and displacing his anger on me at the time. Then several days later I got word that he’d broken up with his boyfriend. I tried to be as polite and understanding as possible, and I told Ben that he’d be missed as we’d initially made plans that Friday night, me tellng him to be good despite the breakup. Only his reaction took me by surprise, it wasn’t something I had expected given my words weren’t rude or mean-spirited.

I didn’t know how to respond; I didn’t know why he was so pissed off… how was I guilt-tripping him with anything? But the next text I sent came back saying that it couldn’t be sent, Ben did exactly what he did in round 1: he blocked me. I was beyond pissed off. This was the ONE thing that I hated more than anything, as it triggered me right back into feeling like I was in the past, in the midst of abuse, and I was livid, I was sad, and I felt desperate, I felt like a part of me died that day.

Ben had broken the one promise I made him agree to in order for me to participate in his vision of us being together. I became angry, and one thing was certain: I was not going to let him get away with it again.

No way in hell.

Ben was going to be held accountable for that one damn promise, after all, I’d stayed true to my word in everything I’d said I’d do for him. Ben came into my life, he’d brought me the warmest, brightest, most intoxicating love I’d ever experienced; he’d made me all these promises I didn’t ask for – and they all were nothing but words in the end. I was somewhere between having a seizure and a panic attack as I tried reaching him by phone using various numbers, only to have him hang up as soon as he heard my voice. If I thought the feeling his first discard left in my stomach was queezie, this was 10 times worse. I was set on a mission to make him keep his word… after all… he knew about the psychopath in my recent past. For him to do something like this, which resembled that incident quite a bit, went against his entire mission statement: to help me get better. This didn’t help me get anything but worse. Why the hell did I even want him in my life if he’d done this to me… twice? Why couldn’t I clearly see the writing on the walls and leave? All it took was noting his smell on my pillow, or anything that reminded me of Ben, and my mind was right back stuck on him. And it wouldn’t stop being stuck either… at least not for quite a while.

First and fourth songs written / performed by me, and as always, for Ben.

Narcissists are very cunning creatures and it is virtually impossible for a ‘normal’ person to wrap their head around this because Narcissists can and do act as if they are perfectly normal, and SANE! They are magicians that use ‘smoke and mirrors’ to get you to BELIEVE in their magic – but in the end you realize it was ALL hocus-pocus!

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Scroll down read about covert narcissism in the Huffington Post.

Imagine that a dear and beloved friend gave you the gift you always dreamed of — your very own Rolex watch! Not only did you treasure the gift, but you have been ecstatic ever since your incredibly generous and kind friend bestowed you with this wonderful and thoughtful gift. Although surprised with the gift, it didn’t shock you, as you were privy to stories about his generosity and kindness to others, who similarly longed for something he was able to give them.

A few months after receiving your gorgeous Rolex, you notice that the crystal has taken on some scratches, which seems unlikely since Rolex watches are known for their scratch resistant sapphire crystals. Three months after that, the unbelievable happens: the watch begins to lose time! You don’t dare mention it to your friend for fear of appearing ungrateful and disrespectful. You choose to keep it a secret, as the watch is more than just a timepiece to you; it is symbolic of the closeness that you and your friend share. After all, you think, it’s not a big deal that your beautiful watch loses only a few minutes a day. No harm, no foul.

To your great surprise, six months after first receiving your cherished gift, your scratched and poorly functioning but beautiful Rolex stops working altogether! Confused but curious, you bring it to a watch repair shop, where you learn that the treasured gift from your treasured friend is a fake; nothing more than a $75, made in China, counterfeit!

With the best intentions, you kindly and sensitively email your friend to let him know he was duped into buying a counterfeit watch. You recommend that he pursue some form of compensation from the criminal jeweler who sold it to him. Although “duped” and “criminal” may not have been the best choices of words, you trust your friend to take it in the spirit in which it’s intended. His response confuses you, as the shared experience of disappointment and frustration you expected was countered by anger and defensiveness. He blames you for prematurely jumping to conclusions, judging him, and being irresponsible and reckless with the valuable gift he unselfishly gave you. The situation gets even more bizarre when you realize that the group of seven men who belong to your shared social circle are carbon-copied on this particular email conversation.

Shocked and dismayed, you reflexively respond to him alone with a firm “chill out” and “back down” message, while asking why he would include the guys from your group in this conversation. This response lights him up like a match thrown into a puddle of gasoline. In a fit of indignant anger, he demands that you return the watch to him so he can disprove your “baseless and vindictive” allegations.

Following your well-meaning attempts to calm him down, diffuse his defensiveness and get him to stop blaming you, you notice that his personality shifts to one that is aloof, cold, and disinterested in hearing anything more about your experience of disappointment. Being confused and stunned by the sum total of his anger and apparent retaliation for your simple heads-up about the watch, you naturally comply by returning the watch to him. You don’t dare challenge his bizarre request because its abundantly clear that doing so would trigger him to an even higher level of histrionic and displaced anger. Plus, you are already embarrassed because all the guys in your group are now privy to this private matter. Little did you know that, by returning the watch, you also forfeited any possibility of clearing your name and restoring your reputation that has been tarnished by this unfortunate and unfair smear campaign.

You will be left trying to reconcile how and why your friend’s empathy, altruism, and sincerity disappeared in an instant and unexpectedly transformed into a laser-focused crusade to hurt you. After careful consideration, you decide to let the whole situation go, as the cards are already heavily stacked against you. Unfortunately, it’s too late and the domino effect can’t be stopped as you learn through the grapevine that your former friend has masterminded a smear campaign that will culminate in an expressed directive to exclude you from all future group activities. The “out of left field” abandonment by your friends will add another layer of trauma and betrayal.

You will be left with a “WTF” set of feelings, while trying to piece together what happened and why. Similar to other victims of covert narcissists, you will sadly realize that your “friend” and the friendship were never real. You may also come to the deeply disappointing conclusion that your counterfeit friend deceived you and others by creating multiple layers of fabricated personality traits, which were designed to benefit him. In other words, you will be shocked at the realization that your friend’s generous, unconditionally loving and altruistic persona was nothing more than an Oscar-worthy performance that was developed, practiced and honed through a long list of other discredited and discarded “friends.”

What you will soon learn is that this beloved friend was always a covert narcissist and the friendship you so dearly appreciated and valued was nothing more than a counterfeit, much like the Rolex watch.

Covert narcissists are masters of disguise — successful actors, humanitarians, politicians, clergy members, and even psychotherapists who are beloved and appreciated, but are secretly selfish, calculating, controlling, and vindictive. They create an illusion of selflessness while gaining from their elevated status. Although they share similar basic traits with the garden variety narcissist, i.e., the need for attention, affirmation, approval and recognition, they are stealthier about hiding their selfish and egocentric motives. Unlike the in your face narcissist, who parades his narcissism for all to see, the covert narcissist furtively hides his real motives and identity.

These narcissists are able to trick others into believing they are honest, altruistic and empathetic individuals. They are successful at pretending to be a more likable version of themselves, knowing that if their true identity was uncovered, they would not be able to maintain the respect, status and prestige that they have so manipulatively obtained.

Compared to overt narcissists, covert narcissists are more reserved and composed. By not advertising their deeper narcissistic values and motives, they are able to achieve their goals, while protecting their innermost insecurities and vulnerabilities. Unlike overt narcissists, they expend a great deal of psychological energy containing or hiding their callous, indifferent, and manipulative inner selves. Even though covert narcissists have repressed the full scope and magnitude of their personality disorder, on a semi-conscious level, they are aware that their fantasies are embarrassing and unacceptable.

Because covert narcissists are able to create and maintain a facade of altruism and unconditional positive regard, they are able to function in positions that are traditionally not attractive to narcissists, e.g., clergy, teachers, politicians, psychotherapists and others. Even though they are able to replicate the known characteristics of these positions, they are often deeply insecure and secretive about their lack of knowledge or inability to perform the most essential tasks. For example, a covert narcissist who is a psychotherapist will have mastered the stereotypical career-specific, idiosyncratic behavior patterns such as reflective listening, supporting and accepting feedback, and gestures that mimic unconditional acceptance.

However, this covert narcissist psychotherapist will be deficient in the most critical area of the job. Although they attempt to demonstrate honesty, sympathy and empathy with their clients, they ultimately fall short. They are simply unable to master the key elements of the position, as they are inherently judgmental, controlling and emotionally aloof. These therapists often become agitated at their clients when challenged or questioned. Clients who do not let them control the process will often trigger a narcissistic injury.

These secretive and slippery narcissists react to their unmasking with the full force of their arsenal of weapons that you would never guess existed. When they perceive a threat to their carefully and meticulously crafted public persona, all bets are off! Since their personal and professional reputation is built on a foundation of lies and misrepresentations, they will protect it by any means necessary. Their reflex to attack the perceived threat is fueled by an adrenaline-infused survival instinct that is no different than if they were cornered by a pack of hungry wolves. They will try to crush the threat, while positioning themselves as the victim of a premeditated vindictive and grievous harm.

http://www.huffingtonpost.com/ross-a-rosenberg/unmasking-your-counterfei_b_10367886.html

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chestervaldes1-blog · 7 years

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Trump To Avoid Supper With Washington Best.

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letmemarry · 1 year

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#hiv positive marriages, hiv positve marriages website in india,

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letmemarry · 4 months

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HIV Marriages for HIV Positive Brides and Grooms in India

In a society where traditions and societal norms often dictate the path of matrimony, the challenges faced by HIV-positive brides and grooms in India, especially in Hyderabad, are distinctive and demanding. This article delves into the complexities surrounding HIV-positive marriages, shedding light on the need for support, understanding, and the creation of a more inclusive environment.

Brief Overview of HIV-Positive Marriages HIV-positive marriages involve couples where one or both partners are living with HIV. Despite medical advancements, societal stigmas continue to surround these unions.

Importance of Support for HIV-Positive Brides and Grooms The emotional and psychological toll on couples navigating HIV-positive marriages emphasizes the crucial need for support networks and understanding within their communities.

Context of HIV-Positive Marriages in India, Specifically Hyderabad India, with its rich cultural tapestry, faces unique challenges concerning HIV-positive marriages, and the city of Hyderabad is no exception.

Understanding the Challenges

Stigma Surrounding HIV-Positive Individuals One of the primary obstacles faced by HIV-positive brides and grooms is the pervasive stigma attached to their condition. Addressing this stigma is vital for fostering acceptance.

Lack of Awareness and Education A significant hurdle lies in the lack of awareness and education regarding HIV transmission, prevention, and the realities of living with the virus.

Emotional and Psychological Challenges Coping with the emotional and psychological challenges is a journey often traveled in isolation. Counseling services play a pivotal role in supporting these couples.

Navigating the Wedding Preparations

Support Networks for Couples Establishing robust support networks is essential for couples preparing for an HIV-positive marriage. Friends, family, and community organizations can offer invaluable assistance.

Counseling Services Professional counseling services provide a safe space for couples to address their concerns, fears, and aspirations, ensuring they embark on their marital journey with resilience.

Positive Examples and Success Stories Highlighting positive examples and success stories of HIV-positive marriages inspires hope and resilience within the community, dispelling myths and misconceptions.

Legal Aspects of HIV Marriages

Rights and Responsibilities Understanding the legal rights and responsibilities of HIV-positive brides and grooms is crucial for navigating societal expectations and safeguarding their union.

Legal Safeguards for HIV-Positive Brides and Grooms Legal frameworks exist to protect the rights of individuals with HIV. Awareness of these safeguards is vital for ensuring fair treatment.

Navigating Societal Norms and Expectations Balancing traditional expectations with the realities of HIV-positive marriages requires open dialogue and education to foster acceptance within communities.

Wedding Rituals and Traditions

Adapting Traditions for HIV-Positive Couples Customizing wedding rituals and traditions ensures that they align with the needs and comfort levels of HIV-positive couples.

Creating a Supportive Environment Fostering a supportive environment during wedding ceremonies helps create a positive and inclusive atmosphere for the couple and their guests.

Inclusivity in Wedding Ceremonies Promoting inclusivity in wedding ceremonies not only supports the couple but also contributes to changing societal perceptions surrounding HIV-positive marriages.

Community Involvement

Raising Awareness Community involvement is crucial for raising awareness about HIV, dispelling myths, and fostering an environment of empathy and understanding.

Building a Network of Support Communities can play a vital role in building a network of support, ensuring that HIV-positive couples have the backing they need to thrive in their marriages.

Encouraging Empathy and Understanding Creating spaces that encourage empathy and understanding reduces stigma and helps the community embrace the diversity of love.

Healthcare Support

Access to Medical Facilities Ensuring access to medical facilities and healthcare services is imperative for the well-being of HIV-positive brides and grooms.

Importance of Regular Check-Ups Regular health check-ups are vital for managing HIV. Encouraging couples to prioritize their health is essential for a fulfilling marital journey.

Dispelling Myths About HIV Transmission Education plays a crucial role in dispelling myths about HIV transmission, promoting a more informed and accepting society.

Financial Considerations

Challenges in Employment Opportunities HIV-positive individuals may face challenges in employment opportunities. Addressing these challenges through advocacy and support is essential.

Financial Planning for HIV-Positive Couples Financial planning becomes crucial for HIV-positive couples, considering potential challenges in the employment sector. Government and NGO support can play a vital role.

Government and NGO Support Governments and non-governmental organizations can contribute significantly by providing financial support and creating initiatives to empower HIV-positive couples.

Social Media and Advocacy

Utilizing Social Platforms for Awareness Leveraging social media platforms is a powerful way to raise awareness, educate the public, and advocate for the rights of HIV-positive couples.

Advocacy for HIV-Positive Marriages Advocacy efforts aim to break down societal barriers, challenge stigmas, and create a more inclusive society for HIV-positive couples.

Empowering Couples Through Online Communities Online communities provide a space for couples to share experiences.

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headlines-twentyfour · 5 years

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#Blogger

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