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On this World Aids Day, do the right thing – save the TAC, save lives

Saving the Treatment Action Campaign is vital for the next phase of the struggle to fix the public healthcare system, argues Anele Yawa.
I joined the Treatment Action Campaign (TAC) two decades ago in 2002. The organisation was four years old at the time. Back then there were no branches in Uitenhage. Perhaps as a result, it may be more accurate to say that I was one of the co-founders in the area. I joined because the HIV pandemic was ravaging my community. KwaNobuhle, in this sense, was no different from many other communities across the country. According to official statistics, more than 800,000 people died in South Africa from 1997 until 2002 from Aids-related illnesses, and 13% of these deaths occurred in communities in the Eastern Cape.
Since then the TAC has had many highs and lows that coincide with the country’s quest to fulfil the constitutional promise of quality healthcare for all. Like other social and political movements that have shaped post-apartheid South Africa, it may be argued that the TAC is a victim of its own success. In galvanising a groundswell of support across the world in one of our key campaigns, we have suffered the ignominy of having our place in history cemented in a time and place, when the truth is that our work has continued and continues at incredible levels.
In our context, people rightfully acknowledge the role of the organisation as well as that of our vital partners in fighting against Aids denialism as well as for access to antiretrovirals (ARVs). Today South Africa has the largest treatment programme in the world, with 5.5 million people currently on ARV treatment. Countless lives have been prolonged, and research has shown us that people living with HIV (PLHIV) live long, healthy lives, with a similar life expectancy as HIV-negative people provided they are diagnosed early and have consistent access to treatment. This is in distinction from the Mbeki years, during which Harvard University estimated that more than 330,000 lives were lost to Aids-related illnesses.
While our fight, which culminated in crucial Constitutional Court victories that largely extinguished the fire of denialism, it still simmers today. Just in September 2022, Thabo Mbeki, the country’s second democratically elected president and Denialist-in-Chief, reiterated his denialist views in a lecture at Unisa. This has rightly been criticised by many actors, including the South African Medical Research Council, the TAC, SECTION27 and the Progressive ...

Life Esidimeni — seven years of indignity and injustice

It’s been seven years since the lives of the families of patients at Life Esidimeni mental health facilities took a turn for the worse when they discovered their loved ones were being severely neglected and mistreated, and in some cases, died as a result of this.
‘Even if I’m left alone, I will continue fighting for my son. I always hear his voice calling me,” a determined Jabulile Hlatshwayo told those gathered at the Life Esidimeni healing ceremony last weekend.
It’s been seven years since the lives of the families of patients at Life Esidimeni mental health facilities took a turn for the worse when they discovered their loved ones were being severely neglected and mistreated, and in some cases, died as a result of this.
Year seven also marked the second year of the inquest into the cause of the deaths of more than 144 Life Esidimeni patients.
The inquest began in July 2021 after many false starts, with families eager to get clarity and closure on the circumstance that led to the deaths of their loved ones as well as to find out who was responsible. This was after the arbitration process, led by retired Deputy Chief Justice Dikgang Moseneke, named the central players as the former head of Gauteng’s Department of Health Dr Barney Selebano, former Gauteng Department of Health director Dr Makgabo Manamela, and former MEC of Gauteng Health Qedani Mahlangu.
Healing ceremony
Saturday, 26 November was the day of the healing ceremony, organised by the Life Esidimeni family committee, the South African Depression and Anxiety Group (Sadag) and hosted by the Holocaust and Genocide Centre. It was a grey day, reflecting the mood of the occasion, presided over by a pastor who opened with prayer and a spiritual song meant to bring comfort and healing to the families.
The choice of venue was itself significant in that the deaths and neglect of mental healthcare users in such large numbers is one of the blights on our country’s history, particularly such a vulnerable sector of the population that looks to society for protection.
In the Holocaust and Genocide Centre, a particularly haunting quote by Holocaust survivor and Nobel Peace Prize recipient Elie Wiesel reads: “For the dead and the living, we must bear witness.” This clearly declared the purpose of not only the day, but the whole seven-year process of seeking justice for the lost lives of the deceased as well as the acknowledgement ...

‘Equalise’ or lose the Aids battle, UNAIDS warns

Aids will not be eradicated by 2030. The main stumbling blocks are gender inequality, marginalised individuals such as female sex workers, children living with HIV, and inequitable access to resources. This is according to UNAids’ executive director, Winnie Byanyima, speaking at the launch of UNAids’ report Dangerous Inequalities.
The world commemorates World Aids Day on 1 December. The world’s largest HIV epidemic persists in South Africa, with about 8.5 million people in the country living with HIV, according to Statistics SA in its 2022 mid-year population estimate report.
A new report by UNAids, which was officially launched in Dar Es Salaam, Tanzania, on 29 November, reveals that crucial steps, which can set the world’s Aids response back on track, must be taken to tackle inequalities, and calls on countries worldwide to take action.
“In one word: equalise. Equalise access to rights, equalise access to services, and the best science and medicine — it will help everyone,” said UNAids’ executive director, Winnie Byanyima, at the launch of the report.
Equalising for women and girls
“In Sub-Saharan Africa, adolescent girls and young women are three times more likely to be infected with HIV than boys and men of the same age — and the driving factor is inequality,” said Byanyima.
The report noted that an estimated quarter of a million adolescent girls and young women (aged 15 to 24) acquired HIV in 2021, with 82% of them living in Sub-Saharan Africa.
This equates to roughly 4,900 new HIV infections per week among adolescent girls and young women. South Africa is no exception, with the infection rate among adolescent girls and young women rising at an alarming rate.
Statistics from the Thembisa model, a mathematical model of South Africa’s HIV epidemic, indicated that adolescent girls and young women are disproportionately affected. In 2022, the HIV prevalence for adolescent girls and young women was 8.4%, and 3.6% for their male counterparts of the same age. Read more about how South Africa measures up to UNAids’ HIV targets here.
Furthermore, the report indicated that in Sub-Saharan Africa, new HIV infections among adolescent girls and young women are declining at a sluggish rate in contrast to males in the same age demographic. Between 2010 and 2021, new infections among adolescent girls and young women declined by 42%, but during that same period, for males of the same age, the decline in new infections was 56%.
Byanyima noted the importance of comprehensive sexuality education (CSE) in reducing ...

City Power’s 2019/20 electricity tariffs set aside by high court — but who gets a refund?

A second ruling in two months has found the National Energy Regulator of SA has calculated electricity prices in an unlawful manner. This time, for 2019/2020 tariffs that were set without having a cost of supply study that was supposed to have been done by the City of Johannesburg to guide its decision.
After finding that the National Energy Regulator of SA (Nersa) had unlawfully fixed electricity prices for the City of Johannesburg, which at the time increased prices by 13.07%, without a cost of supply study being done, the Johannesburg High Court last week set aside City Power’s electricity tariffs for the 2019/2020 financial year.
At the time, City Power had applied for an increase of 12.2%, but Nersa’s guideline was published at 13.07% and City Power’s application was then amended to the higher tariff.
When the guideline was published at the higher level (13.07%), City Power amended its application to get the bigger increase without any effort to justify the additional burden on consumers.
But the court said that this order will not have a retrospective effect, as it could have a disastrous impact on municipal finances, except in the case of the applicants, a group of companies, who will “resolve by mutual agreement their dispute regarding the applicable electricity tariffs payable for the 2019/2020 tariff year” and if this can’t be resolved it must be referred to Nersa for a decision.
A cost of supply study, by law, should be carried out every five years by every municipality and without it, Nersa cannot assess the cost of supply of different customer categories within the municipality. Nersa’s legal team argued that in the absence of a cost of supply study, the guideline and benchmarking method will be used when setting municipality tariffs.
In ruling against Nersa, Judge Elizabeth Kubushi pointed out that the regulator was compelled by law to ensure cost-reflective tariffs reflect all cost components, which could not be done without a cost of supply study.
In October, Kubushi also declared Nersa’s guideline and benchmarking method to be unlawful after an application brought by the Nelson Mandela Bay Business Chamber and the Pietermaritzburg and Midlands Chamber. Nersa was given a year to update its methodology.
Visit Daily Maverick’s home page for more news, analysis and investigations
At the time, Hasha Tlhotlhalemaje, the general manager for regulation at Eskom, said the power utility welcomed this decision.
“It is essential for electricity prices to municipal customers to be reflective ...

Meet the healthcare workers who choose to live and work in SA’s poorest rural villages

Rural hospitals and clinics struggle to attract or retain senior healthcare professionals. Health workers who grew up in rural towns can plug the gap as they are more likely to work at remote facilities than their urban counterparts.
Nomkhosi Mkhwanazi (35) is sitting in her office at Hlabisa Hospital in the small rural settlement in KwaZulu-Natal that this district healthcare facility is named for, about three hours’ drive north of Durban.
She’s a dietician – the only one at the hospital.
Mkhwanazi grew up in Hlabisa and has spent most of her life here.
She’s also one of around 500 health workers who the Umthombo Youth Development Foundation has helped to study health science since 1999. Like Mkhwanazi, the students are from poor, rural backgrounds and get funded and mentored during their studies.
In return, they’re expected to work at the hospitals in (or near) the towns or villages they grew up in after graduating, for the same number of years that the foundation supported them.
Mkhwanazi was contractually compelled to work in the Hlabisa area for four years, but she’s stayed for far longer. This month, she will have worked here for nine years.
In fact, her desire to help people in her community is what drove her to become a dietician in the first place.
“I always wanted to come back and work here,” Mkhwanazi says. “Before I became a dietician, I was a student nurse here at the hospital. I noticed that many patients didn’t gain weight due to their illnesses or because they struggled to afford food.”
Dieticians provide such patients with evidence-based advice on what kinds of foods they should eat. “If patients are too ill to keep food down, dieticians prescribe the appropriate nutritional supplements,” Mkhwanazi adds.
If the patients that Mkhwanazi was seeing lived in cities such as Cape Town or Durban, they would likely have had a choice of dieticians to consult at public hospitals.
But here in Hlabisa, things are different.
“There wasn’t a single permanent dietician at the hospital until I started working here in 2013,” Mkhwanazi says. “So I decided to study dietetics and then come back to serve my community.”
Visit Daily Maverick’s home page for more news, analysis and investigations
Doctors raised in rural areas are more likely to work there
Mkhwanazi’s story reveals why Umthombo was set up.
People who grew up in rural towns are far more likely than their urban counterparts to take up jobs in rural clinics and hospitals, ...

Bad to worse — massive gap in rightful housing and basic service delivery for Joburg’s inner city low-income residents

Housing shortages are one of the biggest problems faced by the underprivileged in Johannesburg — fuelled by rapid population growth. The City of Johannesburg is facing a 500,000-strong housing backlog, with at least 100,000 people living homeless and 134 buildings illegally occupied, according to the city’s last count five years ago.
For years, the Johannesburg inner city has been characterised by overcrowding and dilapidated infrastructure that has been a headache for city managers. Many buildings are residential apartments, condemned by the city. Criminals have moved in and taken over from absentee owners, or owners who gave up on earning rentals off their assets. Many condemned buildings are illegally occupied by people who can’t afford to pay rent elsewhere in the city.
According to the City of Johannesburg, “abandoned” refers to owners that cannot be traced by the city, no proper management or maintenance is in place, and the condition of the building poses a health and safety risk to occupants and the general public alike. “Hijacked” means the occupiers are neither owners nor authorised agents and the occupation is considered illegal. The owner of the property would also need to supply proof of such in the form of a court order.
Speaking to eNCA in August 2022, Lucky Sindane, spokesperson for the city of Joburg’s Group Forensic and Investigation Services unit, said the city had managed to reclaim 50 hijacked buildings and returned them to their rightful owners.
Nevertheless, due to a lack of affordable and decent housing options in the inner city of Johannesburg, abandoned or hijacked buildings have become homes and refuges for many vulnerable groups.
Life inside ‘hijacked’ buildings
Inside these abandoned or hijacked buildings, makeshift boards and curtains divide the space where the occupants live. Both South African and foreign nationals live in these precarious buildings — crowded, without electricity, water supply or sanitation.
Some live rent-free with no services while others pay exorbitant rent and bribes to slumlords, who impose themselves as rightful owners of a property — usually through intimidation and violence.
The Inner City Federation (ICF) — a civil society organisation in the city — currently represents residents in more than 50 of these “abandoned or hijacked buildings” to legally fight off evictions.
Over the years, ICF in partnership with Seri — a non-profit human rights organisation — has helped “poor” inner-city residents resist eviction, harassment and displacement, by establishing and maintaining effective self-management structures in dilapidated inner-city buildings while collectively mobilising ...

Good, bad and ugly — SA’s agonising battle with GBV and femicide

Almost 1,000 women lost their lives at the hands of their intimate partners between April 2020 and September 2022, according to SA police data. Meanwhile, government reached only one out of five of its targets within its action plan to fight gender-based violence and femicide.
Between April 2020 and September 2022, 988 women were killed through domestic violence in South Africa, police data shows. In about the same period, the government achieved just over a fifth of the targets in its action plan to curb gender-based violence and femicide (GBVF), according to a report released at the second Presidential Summit on the matter held in Midrand in early November.
Because, women’s rights activists say, a national council that was meant to be set up to tackle GBVF is still not up and running — four years since it was promised.
We’ve been here before.
An earlier version of an anti-GBV council was tried in 2012 and was supposed to manage the rollout of the 365-Day National Action Plan to End Gender Violence launched in 2007.
But the group was disbanded within two years because its legal power was poorly defined, it had too little money, and there wasn’t enough non-government representation, the Commission for Gender Equality found.
This time round, two voluntary bodies — the End GBVF Collective and the GBVF Response Fund — were established to get the ball rolling while the government put the legal framework in place for setting up the new incarnation of the council.
The End GBVF Collective is a think tank of researchers and civil society organisations that are responsible for getting the National Strategic Plan on GBVF off the ground, whereas the Response Fund backs community-based organisations to help prevent GBVF from happening and protect victims.
But both these teams were only meant to be stop-gaps and their terms would end once the national council is established. With small budgets, it’s difficult to tackle a scourge that cost the country R36-billion in 2019 alone, according to a research report estimate. (For example, the Response Fund started out with a promise of R162-million; R108-million in cash had been received by the end of February.)
Maite Nkoana-Mashabane, the minister of women, youth and persons with disabilities, the state department that’s responsible for the GBVF action plan, told disgruntled delegates at the second Presidential Summit on GBVF that the National Council on Gender-Based Violence and Femicide Bill will be signed into law before April 2023.
But ...

Cape Town women’s shelters threatened with closure within weeks unless donors found

Saartjie Baartman Centre says it needs R300,000 within the next two weeks. St Anne’s Homes also has a cash crisis.
As the country marks the start of 16 Days of Activism against gender-based violence (GBV), two Cape Town shelters for abused women may have to close down if they don’t secure funding soon.
The Saartjie Baartman Centre for Women and Children in Manenberg and St Anne’s Homes in Woodstock have made a public plea for emergency funding to keep their shelters’ doors open.
On Monday alone, director of the Saartjie Baartman Centre, Advocate Bernadine Bachar said she sent out at least 90 appeals to various funders. “I have to get R300,000 within the next two weeks or we are going to look at closing our doors,” said Bachar.
She said the Centre, which opened in 1999, only gets 29% of its funding from the Department of Social Development (DSD) which itself is currently facing “financial constraints”.
“It’s an ongoing battle. I spend an enormous amount of my time trying to raise funds. The funders themselves are tightening their belts and are unable to commit to [the amounts] they did in the past,” she said. Bachar said they also hosted smaller fundraisers like high teas. But these, she said, barely made a dent in the costs needed to run the organisation.
“The situation is dire. The number of GBV survivors increases every day. One would think that there would be some sort of priority. If the government is unable to bridge our 71% gap, then it should call the role players into the room that can,” said Bachar.
On 23 November, Police Minister Bheki Cele presented the country’s second-quarter crime statistics for 2022/2023. Between July and September 2022, 989 women were murdered and 1,277 were victims in attempted murder cases. Cases reported to the police also reveal that over 13,000 women were assaulted with intent to cause grievous bodily harm (GBH).
A total of 558 children were killed between April and September 2022. Police investigated 294 attempted murder dockets involving children from July to September 2022 and 1,895 assault GBH cases.
In response to the crime stats, Bachar said these numbers did not accurately reflect what was happening on the ground because only a small percentage of women who experience violence against them report it. “However, the upward trend in the stats is something we are seeing at shelters,” she said.
Visit Daily Maverick’s home page for more news, analysis and ...

Qatar 2022 – Woman. Life. Freedom. Football.

Keep politics in sport. The World Cup has reminded us that human joy depends on human rights.
Life is full of irony and poetry.
The Fifa World Cup 2022 is well under way. And already the beautiful game is proving to be beautiful for more than just the dribbling or shooting skills of its talented players. It’s beautiful because, try though Fifa might, you can’t suppress the humanity or solidarity of the people who play it and watch it.
When Qatar bought the World Cup from Sepp Blatter and greedy Fifa officials back in 2010, somewhere in the small text they probably also included a promise that politics and public scrutiny of the host country would be suppressed. For the hereditary, ultra-rich monarchy which routinely violates human rights, this was supposed to be a World Cup sans freedom of expression, without politics or protest.
Sportswashing perfected.
The irony, however, is that it’s fast becoming one of the most political of World Cups. Although they are not on the field, the media and human rights activists have teamed up to shine a light on the brutality of regimes like Qatar, and the grand corruption of bodies like Fifa. Watch, for example, satirist John Oliver drawing on reports from Amnesty International and Human Rights Watch, castigating the “atrocity stadiums” that have been built at the cost of an estimated 6,000 migrant workers’ lives: Qatar World Cup: Last Week Tonight with John Oliver (HBO).
Although counterintuitive, this may be a reason that we should take big global events – and all the media that accompanies them – to the least democratically hospitable corners of the world. Perhaps it’s a reason that, despite the justifiable discomfort of climate activists, COP28 should be held in the United Arab Emirates, one of the world’s leading oil guzzlers and producers?
Iran’s team wins
In 2022, long before the final has taken place, the World Cup has been won by the players and people of Iran.
First, in their opening match, the Iranian team kept silent as their national anthem was played. In their second game after threats and intimidation from the government at home (including the chilling arrest of one of Iran’s most famous football players) the team sang the national anthem. But their muted voices gave literal meaning to the words “lip service”.
With their players “silenced”, it was the Iranian fans who picked up the baton. One woman held up a football shirt bearing the ...

The ‘market square’ in South Africa and Colombia — a universe of potential unity to explore

Markets can support community links in contexts that would otherwise be difficult to build because of spatial geography and disconnect across communities — something South Africa could greatly benefit from.
Hernan, a vendor of fresh fruit and vegetables, started working at the “Twelfth of October” food market in Bogotá, Colombia, in 1979. Back then he says there weren’t so many big supermarket chains, and his sales went a long way. Nonetheless, the market has improved a lot over the past years, especially since the space and its infrastructure have been renovated. The market was constructed originally in 1952 and is one of 19 ‘market squares’ (or food markets) on public land, supported through a food market programme by a unit of the local government administration called the Institute for Social Economy (Instituto Para La Economía Social — Ipes).
Bogotá, Colombia’s capital city with nearly 10 million people, stretches from north to south along the Andes’ eastern corridor, with the city becoming considerably poorer the further south it goes. Market squares — as the name suggests — play a crucial role in the life and culture of every neighbourhood, the broader food system, and the economy.
Indeed, the markets are “cultural epicentres” as Francisco Rodriguez from Ipes explains, where communities themselves develop around food — in the market, there is an “entire series of events associated with food”, the preparation, the conversation, and the environment. For Francisco, the market is both a “social and cultural experience and also a sensory experience — the smells, the colours, the flavours.”
The market as an expression of its neighbourhood
In the southern Bogota district of San Cristobal, the “20th of July” market has existed for around 50 years. San Cristobal is amongst the city’s four districts with the lowest household incomes.
Dora has been working at the market for 30 years. She sells a range of products, particularly medicinal plants and herbs. She says the economy is tough right now. But on the weekends the market is a draw for the huge crowds that come to the well-known church, Divino Niño. People make pilgrimages to the church from all around the region and even from outside of the country and the market serves these crowds on weekends. There is also now a pop-up farmers market during the weekends with produce coming directly from surrounding small-scale farmers.
Still, on a Thursday morning, the market is bustling, selling a wide variety of products ...

Prisons watchdog needs sharper teeth to demonstrate effectiveness and commitment

Judicial Inspectorate for Correctional Services is struggling for independence.
After 27 years in apartheid’s prisons, Nelson Mandela emerged free, the world’s most famous prisoner. He never forgot others who, like him, suffer imprisonment. One practical innovation he bequeathed was a commitment to a radically new vision of prisons and how we treat prisoners.
Our new democracy’s leaders — many of them former inmates — understood that apartheid’s prisons enforced a brutal, discriminatory system. By contrast, our democratic aspirations embraced human rights and dignity for everyone — including arrested and detained persons.
The new dispensation explicitly guaranteed incarcerated people all rights — except where justifiably limited. Most particularly, the new Bill of Rights promised all detained people conditions of detention “consistent with human dignity”.
In accord with this, Mandela’s Parliament enacted the Correctional Services Act (CSA) in place of apartheid’s prisons statute. The CSA guaranteed rights and obligations, minimum standards of detention, parole processes and community corrections — plus accountability and oversight.
Its brightest innovation was the creation of the Judicial Inspectorate for Correctional Services (Jics). Unlike many prison inspectorates abroad, which are headed by medium-level functionaries, Jics would have a judge at its head, insulating its independence. It was supposed to make a difference.
Jics’s job is to inspect, investigate, report and make recommendations on conditions in correctional centres and the treatment of inmates.
The statute gives Jics a broad mandate plus specific powers. Jics can enter any correctional centre, interview all staff and any inmate, facilitate the resolution of complaints, and cast a searchlight on the darkest corners of the carceral system.
Despite our history, and great legislative promise, Jics has not transformed South Africa’s prisons.
As Jics’s reports repeatedly record, they are overcrowded, dilapidated, and dangerous. The great majority inside are not offered a chance of meaningful rehabilitation. Many are plunged into a culture of violence and gangsterism, which squeezes out the chance for reform and reintegration on release.
Most unsettling of all is this: there is a nearly-unbroken line connecting prisons of the apartheid era with those of our democracy.
Apartheid disproportionately locked up men of colour: in democratic South Africa, we still do. Despite efforts at reform, South Africa’s prison population is overwhelmingly black and coloured. We have — by far — the highest number of people in prison anywhere in Africa — and the 12 highest in the world. It is a lamentable situation.
Worse, serious human rights violations are rampant in our prisons — and they ...

Pandemic Preparation – the government needs to set up a permanent response initiative urgently

A pandemic preparedness strategy should be a high-level, cross-cutting mechanism to coordinate the national components of a robust public health initiative that plans for future pandemics and activates emergency responses when a new pandemic risk develops.
This is an updated version of an early essay on Daily Maverick in April
The Covid-19 pandemic came as no surprise to infectious disease specialists, as this had been anticipated for decades. Although the spread of a virus from one species to another is, fortunately, a relatively rare event, viruses do have potential to adapt to a new species environment with the potential to spread to become a pandemic. Therefore, it is imperative that countries develop robust strategies for responding to pandemics, supported by clear operational plans at national and subnational levels. This piece argues in favour of a structured, nationally mandated and coordinated, permanent programme to achieve this.
Almost two decades before Covid-19, we were warned of this risk with the spread of two other coronaviruses to humans. There was the “first” Severe Acute Respiratory Syndrome (SARS-CoV-1 virus) in 2002-4, which spread from bats and infected about 8,000 people in China and had a mortality of 8%. Again in 2012, the Middle East Respiratory Syndrome (MERS) virus spread from camels to humans and infected 2,500 people, killing more than 30% of those infected. Pandemics such as HIV/Aids, influenza and Zika are among those that have spread to humans and added to significant human suffering and death. The 2013-16 epidemic of Ebola in West Africa caused 11,323 deaths and had significant human suffering and socioeconomic impact on Africa.
Despite these warnings, the world was still caught unprepared for a pandemic such as Covid-19. As millions succumbed to the various waves across the globe, hospitals became overwhelmed, PPE supplies were in short supply, oxygen was unavailable for severely ill patients, diagnostic tests were unavailable and scale-up took months instead of days/weeks. Surveillance systems were lacking in most parts of the world, and appropriate national intervention teams often did not exist – even in the most resourced countries. Even when effective vaccines were developed in a timely manner, there were limited national plans for acquisition and equitable distribution. Manufacturing capability in LMICs was limited to countries like India. Investing in long-term public health does not garner votes and is just not attractive politically almost anywhere in the world.
The result of this lack of pandemic preparedness was that millions died, the ...

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