World Soccer’€™s Hidden HIV/AIDS Epidemic and the 2010 World Cup

Written by Health-e News

OPINION: “I’ve written this article to argue that FIFA, as the world’s football authority, has an ethical responsibility for social action, in fact, it owes the soccer-playing world – effectively all of humanity – a massive sustainable and measurably successful longitudinal social project starting from THIS World Cup, a moral imperative on which millions of lives will hang in the balance. By Richard Witzig

Every four years the world’s biggest sporting event ‘€“ the FIFA Soccer World Cup ‘€“ occurs with massive global fanfare, with the 2010 event expected to draw tens of billions of television viewers for the 64 matches. The month’€long event is run by the Fédération Internationale de Football Association (FIFA), an international organization comprised of the soccer (known as ‘€œassociation football’€ or just ‘€œfootball’€ in most of the world) associations of 208 countries and states ‘€“ a number larger than the official 192 of the United Nations.

The 2010 event is unique in World Cup history dating back to 1930, as this 19th edition is hosted for the first time in the continent of Africa, humanity’€™s motherland. The host country is South Africa, which as paleoarcheologist Curtis Marean explained in his 2008 Nobel Conference lecture is likely the original site of ‘€œmodern human behavior’€ as evidenced by the recent discovery of the earliest symbolic behaviors from 100,000 years ago ‘€“ surpassing European cave painting evidence by >50,000 years. In other words, progressive intelligent human culture ‘€“ modern Homo sapiens ‘€“ appears to have originated in South Africa. So while the British like to say (and sing) that ‘€œfootball is coming home’€ because the soccer rules were codified in London in 1862, in reality soccer has really come home for humanity with the 2010 World Cup in South Africa.

South Africa is also former site of a modern social slavery system known as apartheid, which ended just 16 years ago when Nelson Mandela was elected President in 1994. Rugby attempted the first social unification of the population with mixed results during the 1995 Rugby World Cup held in South Africa. That event recently commemorated in Clint Eastwood’€™s 2010 film Invictus was then followed by the equally satisfying South African African Nations Cup soccer win in 1996. There are now great hopes among political and media personalities ‘€“ but few activists or academics ‘€“ that the 2010 Soccer World Cup has the potential to ‘€œunify South Africa.’€

Nelson Mandela famously said that ‘€œsport is more important than politics,’€ meaning that sport can reach more places potentially effecting change than governmental structures. But domestic critics of the 2010 World Cup are concerned about corruption and that the South African masses still held captive in poverty will see no or even a negative benefit. These include South African reporter Chris Rodrigues’€™ brilliant Guardian exposé ‘€œSouth Africa’€™s World Cup is a Disgrace’€ detailing the spiraling poverty and inequity measured by the Gini coefficient and the 13’€year decrease in life expectancy since apartheid ended; the Institute for Security Studies in South Africa’€™s just released book ‘€œPlayer and Referee: Conflicting Interests and the 2010 FIFA World Cup’€ examining the lack of transparency and dubious public benefit of the World Cup; and the film ‘€œFahrenheit 2010: A Matter More Important than Life or Death’€ inquires as to who will really benefit from the diversion of billions of dollars of public funds. Acclaimed South African musician Hugh Masekela said ‘€œThere are 47 million people in South Africa, maybe 20 million of them are dirt poor; I don’€™t think the World Cup is even going to touch them.’€ Even ex’€New York Cosmos coach Eddie Firmani, who grew up in South Africa, said ‘€œI think there’s something quite unsettling about spending so much money on new stadiums when so many people are so poor.” It is undeniable that the $5 billion spent on new stadiums and infrastructure facelifts for the Cup ‘€“ mostly for the benefit of the haves ‘€“ could have been spent providing new housing for 250,000 poor people or safe water and steady electricity to millions. But is it too late for the 2010 World Cup to make a permanent positive difference in South African and African lives to fulfill Mandela’€™s conviction? The outcome depends on how FIFA handles the human element outside of the stadium, and whether they match up against other sports’€™ past efforts for health and human rights.

Besides the poverty and staggering inequity in South Africa is its HIV/AIDS epidemic, the worst in the world. There is no escaping this subject, as more than 5.7 million people in South Africa ‘€“ one in nine individuals ‘€“ is HIV’€infected, and nearly 2 million children have already been orphaned by AIDS. It is no wonder the HIV/AIDS epidemic has been called ‘€œthe new apartheid’€ in South Africa.

I’€™ve written this article to argue that FIFA, as the world’€™s football authority, has an ethical responsibility for social action, in fact, it owes the soccer’€playing world ‘€“ effectively all of humanity ‘€“ a massive sustainable and measurably successful longitudinal social project starting from THIS World Cup, a moral imperative on which millions of lives will hang in the balance. FIFA owes humanity service for social issues because they have been downplaying important health and human rights issues affecting world football such as HIV/AIDS and xenophobia all along. Also, the overwhelming percentage of professional footballers ‘€“ from Pelé to Eusébio to Johan Cruyff to Diego Maradona ‘€“ come from poverty or financially disadvantaged childhoods, and world football owes a tremendous debt to these poorer communities who by their resourcefulness allowed master’€class footballers to develop.

The Swiss FIFA President Sepp Blatter claims that FIFA has been ‘€œcommitted to a wide range of humanitarian projects’€ but after objective examination it is clearly only tokenism with substandard outcome evaluation. The FIFA ‘€œFootball for Hope’€ project is costing only about $17 Million while FIFA will have revenues of $3.3 Billion and profits of $1.7 Billion from the tournament ‘€“ that’€™s 0.5% of the revenues and 1% of the earnings ‘€“ an absolute pittance for South Africans (actually less for locals as the small project monies will be spread in different sites in Africa). FIFA’€™s new motto ‘€œFor the Game, For the World’€ is a suitably vacuous slogan no doubt costing a hefty sum to some marketing firm, but fans that care about soccer’€™s human development potential wonder ‘€œWHAT for the Game, and more importantly, WHAT for the World?’€ Soccer fans should not be subjected to such hyperbole from FIFA unless it is ensured that there is serious commitment behind their ‘€œFor the World’€ cliché.

By virtue of being the world’€™s most popular sport it seems strange that several famous athletes from other less popular sports such as Magic Johnson (basketball ‘€“ 1991), Greg Louganis (diving ‘€“ 1995), and Arthur Ashe (tennis ‘€“ 1992) are known to be living with HIV/AIDS (exception is Ashe who died in 1993), but there is simply no comparable soccer figure with an acknowledged HIV/AIDS history. As more people play soccer around the world in more places one would realistically expect that HIV/AIDS would have appeared earlier and be more widespread than in another sports. Perhaps world soccer has been spared the HIV/AIDS epidemic? Unfortunately it has not, but it has ignored a hidden HIV/AIDS epidemic in which ‘€“ unlike the above athletes who all contributed greatly to HIV/AIDS awareness and empowerment ‘€“ survival is the exception.

The first important soccer player (and athlete) who died of HIV/AIDS played in the 1974 FIFA World Cup in West Germany and died in 1985, six months before the HIV virus was officially named and long before the above sportsmen had their status divulged. When I heard this player’€™s story in 1986 it was personal then as we had played on the same team, and it is personal now as I complete 25 years of diagnosing and treating people living with HIV/AIDS.

I heard the hidden news one early morning in June 1986 during my night call duty when I had a conversation with Dr. PL, a Haitian doctor and one of my mentors in my medical training program in New York City. As often happens with persons born outside the USA the conversation drifted to world soccer, and PL was pleasantly surprised to learn that I played on the same club team as two members of his 1974 Haitian World Cup team. After I mentioned that I wanted to contact them and if he could make some inquires for me, PL’€™s mood instantly changed from jovial to pensive as he said,

‘€œYou didn’€™t hear about Fritz?’€

‘€œNo, what?’€

‘€œHe died.’€

Died? I thought. From what? A car accident?

‘€œDied? He couldn’€™t have been more than 37! From what, how?’€


‘€œHe had the virus.’€

Virus? Hepatitis B? Or the newly named HIV virus we were seeing in the New York City in 1986?

‘€œWhat virus?’€

PL confirmed it, ‘€œAIDS.’€

We were talking about Haitian striker Fritz Leandre, who came from the city of Cap Haitian in northeast Haiti to perform on the greatest football stage, the World Cup. Fritz had immigrated to the USA shortly after the 1974 World Cup, notably being involved in the buildup of Haitian star Emmanuel ‘€œManno’€ Sanon’€™s smashing goal against Argentina. We met in 1976 while playing for SC Elizabeth in New Jersey, a club in the New York City’€area Cosmopolitan League. SC Elizabeth was known informally as the ‘€œElizabeth Germans’€ because the club was run by German expatriates who loved soccer, although by that time the team was fully international. Fritz was first and foremost a delightful extrovert who got along with everybody, and after games we would retire to the clubhouse for a meal of beer, bratwurst and multi’€lingual conversation. On the field Fritz was a very technical and good team player; off the field he could sing and play guitar well. Fritz was affectionately welcomed by the ‘€œGermans’€ and actually ended up working for several of them. But he fell ill in 1984 and returned to his older brother Marion’€™s house in Port’€au’€Prince to attempt a recovery.

Fritz was especially close to Marion, also a player on the 1974 Haitian World Cup team.

Back home with Marion he saw a specialist who diagnosed him and treated him for Pneumocystis pneumonia (PCP) multiple times in 1984’€85. HIV was only just discovered in 1983 in France, a test became available in the more developed countries only in 1985, and it was finally officially named HIV in May 1986. But in a 2008 interview in Port’€au’€Prince, Marion and the remarkable pulmonary specialist Dr. Fritz Guillaume (who treated Fritz) confirmed that he died of PCP ‘€“ an AIDS’€defining diagnosis ‘€“ in December 1985.

This was a difficult admission for Marion who by nature has a more reserved personality than Fritz. While Fritz led an improvisational life inspired by joy, Marion is more of a planner and serious’€thinking individual who published books on international soccer and politics. To his credit, Marion is willing to have Fritz’€™s death be known so as to raise HIV/AIDS awareness and save future lives, especially in world soccer. So moved was Marion reminiscing over Fritz’€™s death he said he wanted to write his next book on ‘€œlove,’€ a subject even more poignant after the 2010 Haiti earthquake disaster.

Brazilian center forward Eduardo Esidio is the only acknowledged footballer living with HIV, as all other players have avoided divulging their status because of the unwarranted but widespread social stigma of HIV/AIDS. Esidio had already signed a contract with top Peruvian club Universitario in 1998, when during his physical examination he was tested for HIV without his knowledge. When the test revealed he had HIV infection the Universitario administration was hesitant about honoring Esidio’€™s contract, but fortunately the case never needed to go to court as Peru had in 1993 already signed into law a statute banning job discrimination based on HIV status. A modest and reserved individual, Esidio allowed his boots to show his personal and soccer qualities as he became an immediate sensation with Universitario scoring goals left, right and center.

 With Esidio providing the goal thrills, Universitario won three straight Peruvian professional soccer championships from 1998’€2000, and in 2000, he smashed the single season record with 37 league goals. This accomplishment garnered him two impressive honors: Top Scorer in South America award and the World’s Second Best Top Division Goal Scorer (the ‘€œWorld Silver Boot’€ award). He then moved to Alianza Lima in 2001 and won another championship making it 4 in 4 years in Peruvian soccer. Through his steadfast nature and skill Esidio ‘€“ like Magic Johnson ‘€“ showed that it was possible to perform at the highest level while living with HIV. Another noteworthy aspect of Esidio’€™s time in Peru was the upstanding behavior of the Peruvian press, which actively sought to protect Esidio from unwarranted prejudice and wrote only on his considerable soccer merits. Unfortunately, Esidio never got a deserved chance to play for the Seleção (Brazil national team); he has now retired and returned to Brazil.

Closer to the 2010 World Cup home, two South African national team (called the Bafana Bafana ‘€“ ‘€œThe Boys’€) players have died of AIDS. Sizwe Motaung was vice’€captain of the Bafana Bafana and played in the 1996 African Cup of Nations championship team and professionally in Switzerland and Russia. Motaung married Zodwa Khoza and they had a daughter, but divorced after he was diagnosed and he went from being a steady force in the national team to dying in 2001. Zodwa was the daughter of Irwin Khoza, a fixture in South African soccer for decades as the president of the Orlando Pirates, president of the South African Football League, and one of the main 2010 World Cup organizers. Zodwa also succumbed to HIV/AIDS in 2006 at the age of 30. More recently Jacob Lekgetho, who was on the 2002 FIFA South African World Cup team and who played professionally in Russia, died of HIV/AIDS in 2008.

What adds to the heartache is that these three deaths were probably unnecessary, since at least 1996 combination antiretroviral (ARV) therapy has been available. Most patients who are adherent to ARV therapy do extremely well, and their HIV is managed more like diabetes or hypertension. This modern treatment surely was available to the privileged class in South Africa that Sizwe, Zodwa, and Jacob once belonged. It’€™s likely that a combination of HIV/AIDS ignorance, fear, oppression, and stigma resulting in patient denial contributed to their deaths rather than medication failure ‘€“ in other words, a failure of basic public heath that Mandela has recognized that sport can help resolve.

South African soccer has left some additional human rights concerns unaddressed, such as widespread machismo and homophobia including the horrific crime of ‘€œcorrective rape’€ that deserves to be confronted by world football. A particularly horrific crime occurred in April 2008 when the South African women’€™s team (called the Banyana Banyana ‘€“ ‘€œThe Girls’€) player Eudy

Simelane was brutally raped and murdered by a gang of men. As Simelane was a gay activist the evidence pointed to this crime as a pattern of extreme pathological violence against homosexuality. In South Africa and around the world, gender inequality poses a major threat to HIV transmission and public health, and there is a large medical literature on how xenophobia results in poor health and healthcare outcomes. So far FIFA has ignored addressing the circumstances of Simelane’€™s murder.

The international HIV/AIDS charity AVERT created a sobering video entitled ‘€œThe Other South Africa’€ illustrating that during the 31 days of the 2010 World Cup 4,500 South African children will be born with HIV, 30,000 adults will contract HIV, and 22,500 will die of AIDS (’€cup’€south’€africa.php). And Médecins Sans Frontières (MSF ‘€“ Doctors Without Borders) is running two equally powerful videos called ‘€œA Goal for Life’€ and ‘€œBall’€, wherein African children playing soccer with a rag ball disappear/vaporize into thin air or a human ball rolls over the population, indicating innocent vulnerability to HIV/AIDS.

FIFA is having none of this, as despite the harsh realities (43% of the South African population makes less than $2 per day) they only want feel’€good corporate messages that will not ruin the ‘€œpure soccer’€ mood of the tournament. A disturbing example of this is U2/Bono’€™s ESPN’€FIFA video called ‘€œUnited’€ that should instead be titled ‘€œIt’€™s Not About’€¦.’€, with Bono’€™s words ‘€œIt’€™s not about politics’€¦.borders, history’€¦..human rights’€¦.global pandemics,’€ etc. However, I among several dozen authors have painstakingly written books documenting that world football is integrally involved in all aspects of society, and not just about kicking a ball. By eliminating this connection Bono allows FIFA an excuse to step out of the idea that football can be a ‘€œgame changer’€ for humanity, and effectively sabotages his other HIV/AIDS efforts.

Perhaps FIFA President Sepp Blatter has hypnotized Bono into not recognizing the 2010 World Cup’€™s absolutely singular opportunity to attack HIV/AIDS stigma worldwide? Right now an alliance of at least ten South African HIV/AIDS organizations ‘€“ including the courageous Treatment Action Campaign ‘€“ are protesting for the right to distribute HIV/AIDS information and condoms near the World Cup stadiums and fan events, only to be rejected outright by FIFA.

All of this is taking place against a desperate background of global donor retreat on HIV/AIDS testing and treatment. Donor agencies and governments, including the current USA administration, are now backing away from HIV/AIDS containment goals despite the ever’€increasing need for life’€saving treatments. While science can now attain the ‘€œLazarus Effect’€ with anti’€retroviral (ARV) medications, these medications will likely become scarcer worldwide. The New York Times recently reported this story as ‘€œAt Front Lines the AIDS War is Falling Apart’€.

But what to do as the World Cup has already arrived? FIFA does not have any formal social responsibilities and under Mr. Blatter has had its share of financial irregularities and corruption allegations, best outlined in Andrew Jennings’€™ 2006 book Foul! The Secret World of FIFA: Bribes, Vote’€Rigging and Ticket Scandals. So FIFA should really think about what kind of organization world soccer deserves to have and the proper legacy it should leave ‘€“ a maximum blueprint for human development or a corporate skidmark over the African humanscape? However, as a private opaque entity they are only beholden to their own consciences.

FIFA needs to realize that other sports have already done more per capita than world soccer for human development, specifically HIV/AIDS education and empowerment. Cricket, for example, dedicated the 2007 Cricket World Cup in the West Indies to Children and AIDS and allowed the use of the red and blue HIV/AIDS campaign ribbon ( on the national team shirts for the first round and final matches. And Euroleague Basketball made a month’€long campaign with HIV/AIDS awareness/empowerment groups including Mandela’€™s 46664 Foundation wearing the 46664 logo on their shirts.

Euroleague Basketball estimated that their awareness campaign equaled $50 Million of free public health publicity. Extrapolating from this figure FIFA could provide more than $2 Billion of free HIV/AIDS awareness/empowerment public health publicity, enough to silence some critics of the 2010 World Cup concerned about population benefit. And it would be virtually free; all that would need to be done is add a little color to the national team shirts. But while cricket and basketball have already worn their hearts on their sleeve by allowing HIV/AIDS charity logos and ribbons on their shirts, even during world championships, FIFA has always been reluctant to do so unless the logos are from corporate sponsors. And that takes away world football’€™s most potent awareness’€raising weapon ‘€“ worldwide exposure.

FIFA is missing the biggest chance the world ever had ‘€“ or perhaps ever will have ‘€“ to blast away the massive stigma of HIV/AIDS that is so prevalent in South Africa, Africa and elsewhere. It’€™s a mystery why FIFA has not embraced this win’€win model for HIV/AIDS awareness/empowerment that would benefit millions of people around the globe.

The global public heath problem is that people are becoming HIV’€infected faster than ARV’€™s can be provided to make them well again, resulting in continuous HIV transmission. Neither South Africa nor any other country can ‘€œtreat its way out of the epidemic.’€ The only way to control HIV/AIDS is to interrupt transmission; the only way to interrupt transmission is by increasing awareness, education, testing and treatment; and the only way to do this effectively is by destroying the social stigma of HIV/AIDS. Therefore, the only realistic way to interrupt and eventually decrease total HIV transmission is by a massive culture change amongst pre’€sexually active teenagers, especially in Africa. Since the world is mostly soccer’€mad and the sport already induces a whole host of behaviors, in many areas only the world sport can provide access and incentive for this critical human development project. Footballers are young and become sexually active ‘€“ the prime risk category for acquiring HIV/AIDS but also the best social advocates for prevention. The aforementioned HIV’€positive athlete/author Arthur Ashe said that if he was remembered primarily as a successful tennis player he would feel like he was a failure. FIFA is in danger of staging a soccer spectacular but absolutely failing in the human mission.

FC Barcelona provides precedence for these actions as in 2006 the club team broke with tradition and allowed the use of a logo on their team shirt for the first time in over 100 years. The logo was not a corporate emblem but UNICEF, and at the same time FCB committed $10 million to UNICEF. If this can happen in the world of club teams, why not FIFA in the most critical World Cup opportunity ever?

Fortunately, several private charity groups have already started doing soccer’€inspired HIV/AIDS awareness/empowerment programs. The largest and most scientifically robust program is by Grassroot Soccer (GRS), headquartered in the USA but whose personnel are mostly in Africa. The four GRS founders played professional soccer in Zimbabwe in the 1990s’€2000s and noticed that their team mates were dying of AIDS, and decided to do something about it. Their well’€designed behavioral program aims to introduce an effective behavioral social vaccine against HIV/AIDS ‘€“ the only effective way to interrupt HIV transmission as there will likely never be an effective medical HIV vaccine. The 12’€hour GRS program uses soccer as a tool to empower middle school’€age children to make intelligent life decisions, including sexual decisions that will protect them from HIV transmission. So far GRS has the only program to have validated statistically significant decreases in sexual contacts, but their work is not yet finished as the real success indicator will be demonstrating actual decreased HIV transmission. FIFA has given GRS some small monies but GRS’€™s impressive groundwork should have had FIFA eager to copy and massively promote its model in this World Cup.

FIFA has already the done the content, marketing and distribution of their 2010 South Africa World Cup product ‘€“ it’€™s only missing a relevant message. The message should be solidarity and commitment to health and human rights including the world’€™s biggest preventable killers starting with the largest modern pandemic of HIV/AIDS, and eradicating the scourges of all forms of stigma including xenophobia, ethnophobia, homophobia, and HIV/AIDS stigma. FIFA is at the right place at the right time, but the message should be human not corporate, and must be prominent on the team shirts like other sports have done ‘€“ placing Health and Human Rights and the HIV/AIDS Ribbon ‘€“ on the shirts for all to see for this World Cup through to the 2014 Cup in Brazil (the country with the most HIV in the South America) through to 2018 World Cup and beyond. Only continual exposure and time (at least 10 years) will be the answer to destroy HIV/AIDS stigma and xenophobia and reverse HIV transmission, and world soccer can deliver more of both than any other human enterprise.

South Africans in power also need to speak up for their peoples needs’€™, so it hasn’€™t helped that President Jacob Zuma describes the World Cup as ‘€œthe greatest marketing opportunity of our time,’€ and World Cup organizer Danny Jordaan says it is ‘€œthe world’€™s biggest free advert.’€ Biggest free advert for what? If not for taking this unprecedented opportunity to combat HIV/AIDS stigma, much of their population may not soon exist.

This article through announcing players who have HIV/AIDS or already died gives them respect they deserve ‘€“ in life or death. Although Mandela, Masekela, and scores of others from all walks of life have had siblings and/or children die of HIV/AIDS, the HIV virus is now eminently treatable, and Eduardo Esidio has shown beyond a doubt that HIV infection will not deter a top’€class footballer even at extreme altitude conditions. The time has come for acknowledging previous losses and building over them, educating and empowering children for an ‘€œHIV’€free generation’€ ‘€“ the only solution to decreasing HIV transmission worldwide.

Mandela again: “Sport has the power to change the world. It has the power to inspire and to break down barriers, and to unite people around the world in a way that little else does. It talks to the youth of the world in a language that they understand. Therefore, it is important that we use this powerful vehicle for unity, to rally support for the HIV/AIDS cause. History will judge us harshly if we fail to do so now, and right now.” Is FIFA going to leave this once in a lifetime opportunity unfulfilled for humanity?

HIV/AIDS is simultaneously a ‘€œdisease of poverty,’€ yet anybody ‘€“ doctors, lawyers, footballers ‘€“ can get it if they don’€™t know how to protect themselves. Of course the wealthier are always more informed than those in poverty so the disease is more prevalent in poorer populations. But stigma plays a critical role in continuing transmission, and this must be rectified in all socioeconomic classes.

Recently while attempting to confirm Fritz’€™s story I tried to contact Dr. PL, and telephoned one of our former colleagues to locate him.

‘€œYou didn’€™t hear about PL?’€ he said.

‘€œNo, what?’€

‘€œHe died.’€

‘€œDied? He couldn’€™t have been more than 37! From what, how?’€


‘€œHe had the virus.’€

Your move, FIFA. Ready to wear your ‘€œheart on your sleeve’€ for people, not profit?

Soccer superstar Emmanuel ‘€œManno’€ Sanon at work for the international community.

Haitian Athlete of the Century and 1974 World Cup scorer against Italy and Argentina, Sanon (in black shirt and hat top right) is surrounded by fans in a Haitian bateye in Dominican Republic, where he volunteered for Fútbol Para la Vida, an organization that uses the GRS model for HIV transmission interruption. Despite his illness Sanon made a tremendous difference in HIV awareness and education in a trip just 2 months before he died of pancreatic cancer in 2008.

Earvin ‘€œMagic’€ Johnson Greg Louganis

All’€time basketball great Earvin ‘€œMagic’€ Johnson wrote his autobiography My Life and the HIV/AIDS awareness book What You Can Do To Avoid AIDS in 1992.

Johnson was a prominent member of President George Bush, Sr.’€™s advisory National Commission on AIDS (NCA), but had to resign because that administration refused to take action on NCA’€™s specific recommendations.

Four’€time Olympic gold medalist Greg Louganis (competed in diving in 1976, 1984, 1988) details his complete story in his autobiography Breaking the Surface (1995 and 2006).


Richard Witzig  is an infectious diseases and HIV/AIDS physician based in New Orleans, and the author of The Global Art of Soccer (2006).

His new book World Soccer: How the Beautiful Game Can Make the World More Beautiful expands on this essay’€™s themes and is due out in November 2010.

About the author

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