Inter Press ServiceCountdown to ZERO – Inter Press Service http://www.ipsnews.net News and Views from the Global South Wed, 20 Sep 2017 23:53:02 +0000 en-US hourly 1 https://wordpress.org/?v=4.8.2 Zimbabwe Faces Troubling Spike in Cases of Multi-Drug Resistant TBhttp://www.ipsnews.net/2015/01/zimbabwe-faces-troubling-spike-in-cases-of-multi-drug-resistant-tb/?utm_source=rss&utm_medium=rss&utm_campaign=zimbabwe-faces-troubling-spike-in-cases-of-multi-drug-resistant-tb http://www.ipsnews.net/2015/01/zimbabwe-faces-troubling-spike-in-cases-of-multi-drug-resistant-tb/#comments Sun, 25 Jan 2015 23:29:26 +0000 Jeffrey Moyo http://www.ipsnews.net/?p=138812 About eight years ago, 44-year-old Tilda Chihota was struck with tuberculosis which kept her bed-ridden for over six months at her rural home in Zimbabwe’s Mwenezi district, 144 kilometres southwest of Masvingo, the country’s oldest town. Although Chihota later recovered after receiving treatment at a local district hospital here, early this year, she was once […]

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Caring for MDR-TB patients at home or even at taking them to hospitals is a challenge for relatives, especially as the disease is uncertain to completely go away after treatment. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Jan 25 2015 (IPS)

About eight years ago, 44-year-old Tilda Chihota was struck with tuberculosis which kept her bed-ridden for over six months at her rural home in Zimbabwe’s Mwenezi district, 144 kilometres southwest of Masvingo, the country’s oldest town.

Although Chihota later recovered after receiving treatment at a local district hospital here, early this year, she was once again struck with the same ailment. This time is came with increased severity in the form of multi-drug-resistant tuberculosis (MDR-TB).“MDR-TB cases will continue to increase and worsen as long as the backlog of TB cases keeps increasing." -- Dr. Charles Sandy

MDR-TB occurs when a strain of TB bacteria becomes resistant to two or more “first-line” antibiotic drugs prescribed to combat standard TB.

According to the Ministry of Health and Child Welfare, cases of MDR-TB nearly doubled from 156 in 2011 to 244 cases in 2013. This was despite the fact that notifications for ordinary TB drastically declined from 47,000 in 2010 to 38,367 in 2012.

“I am HIV-positive, but because I defaulted on taking treatment drugs, doctors have diagnosed me with MDR-TB,” Chihota told IPS.

Cases of MDR-TB like Chihota’s are common among people who are living with HIV/AIDS, according to the United Nations AIDS organisation (UNAIDS). Close to 80 percent of TB patients in the care of Doctors Without Borders are co-infected with HIV/AIDS.

“The best way of avoiding MDR-TB is prevention through strict adherence to prescribed treatment by the health provider,” Dr. Charles Sandy, deputy director for the AIDS and TB unit in Zimbabwe’s Health ministry, told IPS.

According to the World Health Organisation (WHO), it takes longer to treat MDR-TB, which can only be cured with the use of very expensive second line drugs that often cause serious side effects.

These include nausea, vomiting and permanent deafness, which often deters patients from finishing their treatment course. On average, patients need to take between 12 and 15 tablets daily for two years, which cost about 5,000 dollars for the entire course.

“The treatment drugs required per each MDR-TB patient are quite expensive and involve the use of quantities of resources enough to treat more than 100 TB patients, which is a strain on government’s public health sector,” Everson Murwira, a local health inspector based in Gweru, a town 222 kilometres west of Harare, the Zimbabwean capital, told IPS.

Medical doctors also point out a litany of many other factors fuelling rising cases of MDR-TB here.

“Food insecurity, large numbers of Zimbabwe’s population living in destitution, lack of balanced diet and crowded and often poorly ventilated homes in both the countryside and high density suburbs in cities leads to TB patients not recovering, but rather further suffering from MDR-TB,” Tinashe Chauke, a private medical doctor often treating TB patients in Masvingo, told IPS.

Chauke added that because most Zimbabweans are poor, “they can hardly afford to visit doctors for regular medical check-ups, resulting in most former TB patients falling prey to MDR-TB.”

But government could be doing more to combat TB.

At last year’s World TB Day commemorations, Health Minister Dr. David Parirenyatwa expressed concern at the number of missed TB cases here, saying that based on WHO projections, Zimbabwe missed 30,000 TB cases in 2013 alone.

“We continue to miss TB cases because of stigma and lack of awareness in the community and limitations in access to health services as well as the quality of health services,” Dr. Parirenyatwa said at the time. World Tuberculosis Day falls on Mar. 24 each year.

Médecins Sans Frontières (MSF or Doctors without Borders in English) says direct observed treatment is the best model to manage MDR-TB.

“Direct observed treatment of MDR-TB patients in their homes by their loved ones is the best option, but in Zimbabwe, only doctors and nurses can inject patients and nobody else, which creates a challenge for patients,” an MSF medical doctor in Harare, speaking on the condition of anonymity, told IPS.

With the help of MSF two years ago, 3,200 patients in Zimbabwe were placed under treatment for TB while 63 patients were treated of MDR-TB.

Government cooperation with MSF, however, has been spotty. In a recent case, an MSF clinic in Beitbridge district near the South African border that treated HIV/AIDS and TB was forced to close after government officials accused the clinic of meddling in politics.

According to MSF, Zimbabwe trails behind other countries in Southern Africa in its response to TB. Diagnostics need improving and treatment needs to be decentralised to community levels, the health agency said in a recent report.

A 2010 UNICEF report revealed that 78 percent of Zimbabwe’s 13 million people were living in ‘absolute poverty’, following which the WHO global tuberculosis report of 2012 placed Zimbabwe’s estimated TB incidence per capita at 603 per 100,000 population.

“Besides inadequate medical facilities, there are also many cases where sick people have needlessly died because they could not access medical attention due to bad or nonexistent roads,” said Edmond Kabarapate, the village head of Kafurambanje Village, said in a recent press interview.

Although Zimbabwe has made significant strides in reducing HIV/AIDS infections to 15.6 percent from 16 percent in 2007, according to the United Nations Development Programme (UNDP), it is still a sad story for this country as it contends with the menace of MDR-TB.

“MDR-TB cases will continue to increase and worsen as long as the backlog of TB cases keeps increasing,” Dr. Sandy told IPS.

Evident of Dr Sandy’s sentiments, the 2009 WHO Global TB Control Report rated Zimbabwe as having the fourth highest incidence of TB in the world. In 2012, the WHO reported that the Southern African nation was amongst 22 countries referred to as the TB “high burden” countries.

Caught up in difficult health situations, especially MDR-TB, many Zimbabweans like Chihota are unsure whether or not they will live after contracting the disease.

“Whether for better or for worse, with the MDR-TB that is wasting me away, taking the complex treatment prescribed to me, I am still very uncertain about what the future holds in as far as my state of health and even my survival is concerned,” Chihota told IPS.

Edited by Lisa Vives

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Zimbabwe’s Children Are the Battlefield in War to Contain HIV/AIDShttp://www.ipsnews.net/2015/01/zimbabwes-children-are-the-battlefield-in-war-to-contain-hivaids/?utm_source=rss&utm_medium=rss&utm_campaign=zimbabwes-children-are-the-battlefield-in-war-to-contain-hivaids http://www.ipsnews.net/2015/01/zimbabwes-children-are-the-battlefield-in-war-to-contain-hivaids/#respond Sat, 17 Jan 2015 21:39:58 +0000 Jeffrey Moyo http://www.ipsnews.net/?p=138689 Fifty-one-year-old Mateline Msipa is living with HIV. Her 17-year-old daughter, born after Msipa was diagnosed with the virus, may also have it, but she has never been tested. “My daughter is not aware of my HIV status and with the stigma associated with the disease, it is hard for me to now open up to […]

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Many children under 15 in Zimbabwe discover their HIV status only when they fall critically ill later in life. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Jan 17 2015 (IPS)

Fifty-one-year-old Mateline Msipa is living with HIV. Her 17-year-old daughter, born after Msipa was diagnosed with the virus, may also have it, but she has never been tested.

“My daughter is not aware of my HIV status and with the stigma associated with the disease, it is hard for me to now open up to her about my status,” Msipa told IPS.“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents." -- 13-year-old Tracey Chihumwe

Msipa’s daughter says she has never attempted to undergo an HIV test despite Zimbabwe’s revised testing guidelines allowing children of her age to get one without parental consent.

“I have no reason to get tested for HIV because I have never engaged in sexual intercourse before,” the 17-year-old told IPS.

Figures show that thousands of children in Zimbabwe are infected with HIV – presenting a major battlefield for government efforts to defeat the spread of HIV /AIDS nationwide.

The U.N. agency UNAIDS estimates that nearly 200,000 children from birth to age 14 have the virus but are not in treatment because they have not been properly tested. It is a trend that researchers term “suboptimal” counseling and testing in that southern African country.

“Children often get tested for HIV [only] when they fall critically ill, which usually doesn’t save them from dying,” Letwin Zindove, an independent health expert who works as an HIV/AIDS counselor here, told IPS.

The new estimate threatens to dash the southern African nation’s effort to meet a U.N. goal of reversing the incidence of infection in the population by 2015.

Older children – between six and 15 – who might have acquired HIV at birth are especially vulnerable to a major outbreak of full-blown AIDS. A study last year by the London School of Hygiene and Tropical Medicine found this group received inadequate access to provider-initiated HIV testing and counselling by primary care-givers.

Lack of clear national standards for HIV/AIDS testing leads to confusion and missed diagnoses in some cases. Credit: Jeffrey Moyo/ IPS

Lack of clear national standards for HIV/AIDS testing leads to confusion and missed diagnoses in some cases. Credit: Jeffrey Moyo/ IPS

The study found health-care workers were reluctant to offer testing which could expose the child to abuse if he or she tested positive. On top of this, long waiting periods for appointments also hindered routine testing and counseling.

Last year, Zimbabwe launched its revised national guidelines for HIV testing and counselling with special emphasis on couples, children and adolescents as it stepped up efforts to halt the spread of the virus ahead of the 2015 deadline of the U.N. Millennium Development Goals (MDGs).

Under these guidelines, a child aged 16 years or older is eligible to give full consent for HIV testing and counselling.

However, the study found that many healthcare workers don’t fully understand the new guidelines.

“They expressed confusion about the age at which a child could choose to test him/herself, what type of caregivers qualified as legal guardians, and whether guardians had to undergo testing themselves first,” it said.

The appearance of a slow-progressing HIV disease among children has also contributed to dangerous delays in testing. New research has found that a substantial number of HIV-infected children survive to older adulthood. Delaying testing and diagnosis until symptoms appear results in a high risk of chronic complications such as stunting and organ damage.

Under the U.N.’s MDG Target 6A, countries should have halted new infections and begun to reverse the spread of HIV/AIDS by 2015.

Zimbabwe’s numbers of HIV incidence may be high (14.7 percent of adults) but the numbers are higher yet in South Africa (17.8 percent), Botswana (23 percent), Lesotho (23.6 percent), and Swaziland 25.9 percent.

Countries with low numbers are Mali, Guinea, Burkina Faso, Benin, Sudan, Senegal, Niger, Mauritania and Somalia – ranging from 1.0 percent to 0.7 percent.

While most countries are achieving a measure of success towards the U.N. goal, two have been a major health care disappointment.

Uganda, once hailed as a Cinderella success story, and Chad have seen a rise in infections. It is a disappointing turnaround from the 1990s when an aggressive public awareness campaign that urged medical treatment and monogamous sexual relationships led to a precipitous drop in infection rates in Uganda.

In 2012, H.I.V. infection rates in Uganda were seen to have increased to 7.3 percent from 6.4 percent in 2005. Over roughly the same period, the United States, through its AIDS prevention strategy known as Pepfar, or the President’s Emergency Plan for AIDS Relief, spent 1.7 billion dollars in Uganda to fight AIDS.

Activists say children are not immune to the deep-rooted stigma surrounding HIV/AIDS here — another barrier to testing.

“Zimbabweans are one huge community, closely-knit, and once a child is tested for HIV, it becomes difficult for it to remain confidential, resulting in any child tested becoming exposed to stigma,” Sifiso Mhofu, an affiliate of the Zimbabwe National Network of People living with HIV, told IPS.

This problem is very real for orphans like 13-year-old Tracey Chihumwe (not her real name) from Mabvuku, a high-density suburb of Harare, the Zimbabwean capital.

“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents,” Chihumwe told IPS.

The Zimbabwean government is now struggling to ensure to that 85 percent of the population – including children and adolescents – knows their HIV status by the end of this year, in a desperate bid to meet the MDGs deadline in December.

But this will not be an easy task.

“Despite revised guidelines of HIV testing for children, pockets of resistance to get children tested for the virus exist from children themselves, parents and guardians as well,” a top government official, who requested to remain anonymous for professional reasons, told IPS.

Edited by Lisa Vives and Kitty Stapp

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SMS for Healthy, AIDS-Free Babieshttp://www.ipsnews.net/2014/12/sms-for-healthy-aids-free-babies/?utm_source=rss&utm_medium=rss&utm_campaign=sms-for-healthy-aids-free-babies http://www.ipsnews.net/2014/12/sms-for-healthy-aids-free-babies/#respond Mon, 29 Dec 2014 17:23:53 +0000 Lyndal Rowlands and Mercedes Sayagues http://www.ipsnews.net/?p=138437 In rural Zambia and Malawi, new mums face long delays finding out if they have passed HIV on to their babies. “What we found with these rural clinics is that often the test results never came back, whatsoever,” Erica Kochi, of the United Nations Children’s Fund (UNICEF) Innovation Unit in New York, told IPS. Without […]

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By Lyndal Rowlands and Mercedes Sayagues
UNITED NATIONS, Dec 29 2014 (IPS)

In rural Zambia and Malawi, new mums face long delays finding out if they have passed HIV on to their babies.

A cool way for Zambian teens to learn about HIV

By Mercedes Sayagues

“My boyfriend says using a condom will give me cancer, is this true?”
“I want to get an HIV test, do I need my parent’s permission? They would be upset! I am 16.”

The questions via RapidSMS keep coming, 600 a day on average, to U-Report, a new HIV counselling service via cell phone for youth in Zambia that boasts 71,000 active users.

U-Report fills in an alarming information gap. Just over one-third of Zambian teenagers aged 15-19 have comprehensive knowledge about HIV, while an estimated 100,000 youth are infected. Many don’t know they carry the virus and are not taking life-saving antiretroviral treatment.

“Young people get infected because they don’t know enough about HIV,” Bright Kaoma, 21, told IPS.
Kaoma presents a program on HIV at Panafrican Radio in Lusaka, Zambia’s capital. On a recent Saturday, the program featured a precocious and outspoken pre-teen.

“Conventional HIV packaging is boring,” said Maxwell Simbuna, 12. “Who wants to go to a clinic to learn about HIV? WhatsApp is more fun!”
Cultural taboos prevent parents from discussing sex with their children. Among 25 youth at a recent meeting in Lusaka, only four had ever talked to their parents about sex.

Bongo Hive

Behind U-Report are the innovation hub Bongo Hive, which developed the software, and the United Nations Children’s Fund (UNICEF).

Launched two years ago, U-Report covers the capital, Lusaka, and the Copperbelt, and soon will reach the whole country, software developer Andrie Lesa told IPS.

The concept is travelling beyond Zambia, as UNICEF is adapting it to the deadly Ebola epidemic in Liberia.

At the call centre in Lusaka, 23 counsellors work in shifts day and night, and the SMS coming are not only from teens. Lesa says that parents also turn to U-Report to find answers to their children’s questions.

HIV testing among U-Report users is 40 percent, nearly double the national average. When U-Report polls users around youth and HIV topics, it receives around 1,000 SMS daily.

“What I learn at U-Report helps me help others,” said a young man, 21, who did not want to be identified. Seven members of his family live with HIV: his father, two of his four wives and four of their children, aged 27 to 3.

The older siblings have joined U-Report. “For the young ones, I am the intermediary,” he told IPS.

U-REPORT FACTS

• 105,000 users signed up
• 49,000 have sent questions.
• 6 in ten users are young men.
• 8-10 and 17-22 hours are the busiest hours
• 84% of Zambians have cell phones
• 14% internet penetration
“What we found with these rural clinics is that often the test results never came back, whatsoever,” Erica Kochi, of the United Nations Children’s Fund (UNICEF) Innovation Unit in New York, told IPS.

Without treatment, a third of babies born with HIV will die before their first birthday and half before their second. Starting treatment within the first 12 weeks of life vastly improves their chances of survival.

But testing babies is not easy in poor countries.

Because mothers pass antibodies to their babies in the womb, the usual adult antibody tests during the first months of life can be inaccurate.

A virological test is needed. But only a handful of central labs can do these in Zambia and Malawi. On the long journey to and from the lab on the back of a motorbike or truck, the blood sample or the result often gets lost.

Some studies suggest that nearly half of tests never reach the clinics or the mothers.

Meanwhile, the new mum returns to her village and she and the baby likely drop out from the clinic’s radar.

Malawi and Zambia each has an estimated one million people living with HIV. In 2012, new HIV infections among children numbered 9,400 in Zambia and 11,000 in Malawi. Just over one third of babies were tested.

The old system couldn’t cope. New ideas and technologies were needed.

Enter UNICEF Innovation with an open source, code-based RapidSMS software: as soon as the lab result is in, the rural clinic’s nurse receives it by SMS on a cell phone or looks it up on the website. In remote villages, a community health worker receives the SMS and alerts the parents.

All information is encoded to ensure privacy and the software includes a web dashboard for reporting and administration.

In Zambia, the turnaround was cut from two or three months down to one month, said Shadrack Omol, deputy representative of UNICEF in Lusaka.

The SMS relaying is part of an antenatal system, Project Mwana (KiSwahili for child), that brings other benefits for all new mums as well.

At the first antenatal visit, the mother’s details are entered in Mwana’s SMS reminder system for alerts on checkups, immunizations, baby weighing and drug refills.

Bundling the HIV component with regular mother and baby care helps avoid stigma and fear of being identified as HIV positive.

In 2011, a Mozambican charity with 22,000 people on ARV treatment tried to build a cellphone database to remind patients of appointments: fearing loss of privacy and stigma, only half gave their cellphone numbers.

In Zambia, Mwana covers 484 clinics in 10 provinces. In Malawi, it has delivered more than 20,000 tests.

The next step, says Emanuel Saka, HIV specialist with UNICEF in Malawi, will be “expanding the geographical coverage and scope of the technology” and targeting adolescents with HIV.

New solutions to old problems

The best solution would be to test babies at the point of care in the rural clinic without any delays. In Mozambique, health workers are trying out a new viral load testing machine that can diagnose young babies in less than one hour.

“This is a great breakthrough,” said Bindiya Meggi, a pharmacist working on this project with the National Institute of Health.

Made by the German company ALERE, the machine is being tried in four sites with the help of the Clinton Health Access Initiative.

“It’s very simple to use,” said Ocean Tobaiwa, a Zimbabwean technician at the trial clinic in Maputo

As the machine is tested, it is adapted to local conditions, such as irregular electricity, black outs, power surges, heat and humidity. German technicians visit regularly to tweak the machines.

At present, babies are tested at one-month of age. A dry blood sample is collected through a heel or finger prick and sent to a central lab for viral load analysis.

Mozambique has only four such labs for a population of 24 million, with some 900,000 HIV positive women, and thousands of kilometers of roads impassable in the rainy season.

Although in theory results should be returned in two weeks, the reality is one month or more. Meanwhile, as in Zambia and Malawi, mother and baby are lost to follow-up.

In Zambia, RapidSMS is the backbone of U-Report, a booming HIV hotline service for young people, which garnered 71,000 users in two years. (see sidebar)

Challenges for testing and treating babies with HIV in Malawi

• Limited HIV integration with other services
• Poor identification of HIV positive children
• Late diagnosis and start on treatment
• Shortage of health staff
• Shortage of laboratory consumables
• Absence of mother-baby cohort registers
• Poor linkages between community and health facility
“Young people much prefer to text than to call up a hotline,” Kochi told IPS.

UNICEF Innovation Labs work with universities and the public and private sector to find new solutions to old problems in health, education, and water and sanitation.

“There is so much to do in the area of technology and real time information that hasn’t yet been explored,” Kochi said.

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For Zimbabweans, Universal Education May be an Unattainable Goalhttp://www.ipsnews.net/2014/12/for-zimbabweans-universal-education-may-be-an-unattainable-goal/?utm_source=rss&utm_medium=rss&utm_campaign=for-zimbabweans-universal-education-may-be-an-unattainable-goal http://www.ipsnews.net/2014/12/for-zimbabweans-universal-education-may-be-an-unattainable-goal/#respond Wed, 24 Dec 2014 16:39:07 +0000 Jeffrey Moyo http://www.ipsnews.net/?p=138406 Zimbabwe boasts of one of the highest rates of literacy across Africa but, but without free primary education, achieving universal primary education here may remain a pipe dream, educationists say. It would also defeat Zimbabwe’s quest to reach the United Nations Millennium Development Goals (MDGs) by the deadline of 2015. One of the MDGs requires […]

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Primary school children like the ones pictured here in Zimbabwe's capital Harare often drop out of school, casting doubts on this Southern African nation's capacity to achieve universal primary education for all by December 2015. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Dec 24 2014 (IPS)

Zimbabwe boasts of one of the highest rates of literacy across Africa but, but without free primary education, achieving universal primary education here may remain a pipe dream, educationists say.

It would also defeat Zimbabwe’s quest to reach the United Nations Millennium Development Goals (MDGs) by the deadline of 2015.

One of the MDGs requires countries the world over to achieve universal primary education by the end of 2015 and reintroduce free primary education. But more than 34 years after gaining independence from Britain, educationists say Zimbabwe is far from attaining universal primary education for all.

“Hordes of pupils enrolled in schools after independence at a time the Zimbabwean government made education free at primary school level,” Thabo Hlalo, a retired educationist from Zimbabwe’s Midlands Province, told IPS.“Without free primary education, school attendance has become intermittent, meaning that achieving universal primary education in line with the U.N. MDGs may remain imaginary for Zimbabwe” – Thabo Hlalo, retired educationist from Zimbabwe’s Midlands Province

”But now without free primary education, school attendance has become intermittent, meaning that achieving universal primary education in line with the U.N. MDGs may remain imaginary for Zimbabwe.”

At independence in 1980, the Zimbabwean government abolished all primary school tuition fees, but they have now crept in and crept up. Parents not only contend with fees that they cannot afford but also with expensive essentials like notebooks and uniforms.

Early this year, Zimbabwe reportedly approached the United Kingdom for funds to help cover fees for an estimated one million pupils who would otherwise be forced out of school. The cash-strapped government said it was unable to finance its Basic Education Assistance Module (BEAM), a scheme meant for poor children.

The U.K. government provided 10 million dollars from its Department for International Development but warned it may be the last contribution.

The school fees have been defended by Zimbabwe’s Education Minister Lazarus Dokora, who has gone on record as saying that parents who default on the fees should be taken to court.

Dokora’s “warning” comes despite the fact that at least 95 percent of Zimbabweans voted in a referendum in March last year to adopt a new Constitution expressly granting free primary education to all. Specifically, Section75 (1) (a) of the Zimbabwean Constitution provides for the right to state-funded basic education.

Despite this constitutional provision, it is still a sad story for many children like 9-year-old Tobias Chikota from Harare’s Caledonia informal settlement located about 30km south-east of Harare, the Zimbabwean capital.

“I dropped out of school early this year because my unemployed parents couldn’t afford to pay my school feels,” Chikota, who at the time was in Primary Four, told IPS.

While it is a requirement for nations to ensure a predictable and adequate state budget allocation to education under the MDGs, civil society activists here say the Zimbabwean government seems way off the mark in terms of prioritising education.

“Despite the impending deadline for the attainment of the MDGs, our government has not been and remains inconsistent in its budgetary structures in practically directing money towards education, which may make the attainment of universal primary education for all difficult, if not impossible, by 2015,” Catherine Mukwapati, a civil society activist and director of the Youth Dialogue Action Network, a democracy lobby group in Zimbabwe, told IPS.

Earlier this year, the Zimbabwean government allocated 919 million dollars to the country’s education sector in its 2015 national budget announcement, but for Mukwapati these were “mere void commitments made on paper, hardly followed by action as customary with our government.

Through UNICEF’s Education Transition Fund (ETF), the Zimbabwean government distributed 13 million textbooks to 5,575 schools countrywide in 2010, resulting in each pupil in primary schools countrywide receiving a set of four basic textbooks.

In spite of this gesture, a 2012 report by Zimbabwe’s Parliamentary Portfolio Committee on Education found that the country’s rural teachers are overwhelmed with work, operating at a ratio of one teacher to 60 pupils, far over the government-pegged teacher-pupil ratio of one to 40.

According to Save the Children, for over 3.2 million children enrolled in primary and secondary schools in Zimbabwe, there are only about 102,000 teachers.

A UNICEF report on the Status of Women’s and Children’s Rights in Zimbabwe released in 2012 says that at least 197,000 pupils drop out of primary schools each year, a situation that development experts here say hinders Zimbabwe from achieving universal primary education for all in line with the MDGs.

“School dropouts owing to lack of school fees, mostly at primary level, are peaking up annually and, therefore, talking about Zimbabwe achieving primary education for all by 2015 is a non-starter,” independent development expert Evans Dube told IPS.

And for many parents like 43-year-old Tambudzai Chihota, a widow whose six children are out of school due to non-payment of school fees, the promise of universal primary education means little.

“My children didn’t go beyond Grade [Primary] Five here because I had no money to pay their school fees and the universal primary education you talk about may not be my business as long as my children are still without access to further education,” Chihota told IPS.

The crisis facing the education system here has also been worsened by the flight of about 20,000 teachers from the country between 2007 and 2009 at the peak of Zimbabwe’s economic crisis.

Besides extremely low salaries, the Progressive Teachers’ Union of Zimbabwe (PTUZ), a teachers’ trade union organisation in Zimbabwe, says that morale is low among teachers, negatively affecting the quality of the country’s education.

An average teacher earns 400 dollars a month, well below the poverty datum line of 511 dollars a month for an average family of five in this Southern African nation.

“Universal education may be far from being achieved here by 2015 due to poor teachers’ salaries, causing a deterioration of the quality of education,” Raymond Majongwe, Secretary General of PTUZ, told IPS.

With just over 12 months left before the deadline for achievement of the MDGs, it appears unlikely that Zimbabwe will meet the target of universal primary education for all.

(Edited by Lisa Vives/Phil Harris)

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Silent Suffering: Men and HIVhttp://www.ipsnews.net/2014/12/silent-suffering-men-and-hiv/?utm_source=rss&utm_medium=rss&utm_campaign=silent-suffering-men-and-hiv http://www.ipsnews.net/2014/12/silent-suffering-men-and-hiv/#respond Tue, 23 Dec 2014 09:29:06 +0000 Davison Mudzingwa http://www.ipsnews.net/?p=138377 Lungile Thamela knows how he got infected with HIV: through his reckless choice to have unprotected sex with his partner although he knew she was living with HIV. He wanted to prove his manhood by having a baby. Instead, he got HIV and was crushed by the burden of self-stigma. Gendered concepts of masculinity influence […]

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Silent Suffering: Men and HIV

By Davison Mudzingwa
JOHANNESBURG, Dec 23 2014 (IPS)

Lungile Thamela knows how he got infected with HIV: through his reckless choice to have unprotected sex with his partner although he knew she was living with HIV.

He wanted to prove his manhood by having a baby. Instead, he got HIV and was crushed by the burden of self-stigma.

Gendered concepts of masculinity influence how men behave around HIV and within antiretroviral treatment (ART) programs.

As a result, the number of men on ART in South Africa in 2012 was half the number of women.

Why are South African men reluctant to test for HIV, to start and stay on ART, and to join support groups?

Is it that health services are not men-friendly? Is it an idea of masculinity that mandates men to be stoic, to hide pain as a weakness and not to talk about their feelings?

What defines the relationship of men to health services and how can it be improved?

In this video by Davison Mudzingwa, experts and activists like Thamela, analyze the factors that drive men’s gendered vulnerability to HIV in South Africa and suggest ways to reduce it.

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Silent Suffering: Men, Manhood and HIVhttp://www.ipsnews.net/2014/12/silent-suffering-men-manhood-and-hiv/?utm_source=rss&utm_medium=rss&utm_campaign=silent-suffering-men-manhood-and-hiv http://www.ipsnews.net/2014/12/silent-suffering-men-manhood-and-hiv/#respond Thu, 18 Dec 2014 16:12:13 +0000 Mercedes Sayagues http://www.ipsnews.net/?p=138332 Across Africa, men have lower rates than women for HIV testing, antiretroviral treatment enrollment and adherence, viral load suppression and survival. Generally, of all people on antiretroviral treatment (ART) in Africa, just over one-third are men. The disparity can be even more dramatic: in South Africa, in 2012, half the number of men were taking […]

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SILENT SUFFERING: MEN, MANHOOD AND HIV

SILENT SUFFERING: MEN, MANHOOD AND HIV

By Mercedes Sayagues
Cape Town, Dec 18 2014 (IPS)

Across Africa, men have lower rates than women for HIV testing, antiretroviral treatment enrollment and adherence, viral load suppression and survival.

Generally, of all people on antiretroviral treatment (ART) in Africa, just over one-third are men.

The disparity can be even more dramatic: in South Africa, in 2012, half the number of men were taking the life-saving drugs compared to women: 1.3 million women and 651,000 men.

At the core of this inequality are socially constructed ideas of masculinity. To be a man means being strong, to ignore pain and symptoms. Hospitals are for women and children.

This idea of manhood leads men to ignore their own health needs. Seeking health care is seen as an admission of weakness.

As a result, men test for HIV and start ART late, sometimes too late to beat the virus.

Manhood brings a mix of personal costs and benefits. Among the costs are men’s poor mental and physical health, and their difficulty to talk about their feelings.

It’s not considered macho to share personal problems. This is one reason why men hesitate to join support groups to help them cope with treatment.

Experts recommend setting up men-friendly clinics with opening hours suitable for working men, recruiting male champions to encourage men to join HIV support groups, and routine co-testing of couples at antenatal clinics.

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Nigeria Struggles to Care for its Adolescents Living With HIVhttp://www.ipsnews.net/2014/12/nigeria-struggles-to-care-for-its-adolescents-living-with-hiv/?utm_source=rss&utm_medium=rss&utm_campaign=nigeria-struggles-to-care-for-its-adolescents-living-with-hiv http://www.ipsnews.net/2014/12/nigeria-struggles-to-care-for-its-adolescents-living-with-hiv/#respond Mon, 15 Dec 2014 15:47:52 +0000 Sam Olukoya http://www.ipsnews.net/?p=138280 HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the No. 1 killer of adolescents. Africa accounts for more than 80 per cent of the 2.1 million adolescents living with HIV globally. In Nigeria, half of the 3.1 million people living with HIV are aged 15-24 years. Drivers […]

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HIV has become the leading cause of death among adolescents in Africa. Credit: Sam Olukoya/IPS

HIV has become the leading cause of death among adolescents in Africa. Credit: Sam Olukoya/IPS

By Sam Olukoya
LAGOS, Nigeria, Dec 15 2014 (IPS)

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the No. 1 killer of adolescents.

Africa accounts for more than 80 per cent of the 2.1 million adolescents living with HIV globally.

In Nigeria, half of the 3.1 million people living with HIV are aged 15-24 years.

Drivers of HIV infection among adolescents include scarce information about sexual reproductive health and HIV, unprotected sex and sexual violence.

AIDS DEATHS AMONG ADOLESCENTS IN 2013

• South Africa 11,000
• Tanzania 10,000
• Ethiopia 7,900
• Kenya 7,800
• Zimbabwe 6,500
• Uganda 6,300


Source: UNAIDS
Tragically, AIDS is now the leading cause of death among African teenagers.

Between 2005 and 2012 the global AIDS death toll fell by 30 percent but increased by 50 percent among adolescents, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Late HIV diagnosis, fear of discrimination, low enrolment and adherence to antiretroviral treatment, and absence of specialized health services for HIV positive youths are some of the factors responsible for AIDS related deaths among adolescents in Africa.

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AIDS Response Is Leaving African Men Behindhttp://www.ipsnews.net/2014/12/aids-response-is-leaving-african-men-behind/?utm_source=rss&utm_medium=rss&utm_campaign=aids-response-is-leaving-african-men-behind http://www.ipsnews.net/2014/12/aids-response-is-leaving-african-men-behind/#comments Fri, 12 Dec 2014 22:13:34 +0000 Miriam Gathigah http://www.ipsnews.net/?p=138253 Mention gender inequality in AIDS and the fact that  more women than men live with HIV pops up. But another, rarely spoken about gendered difference is proving lethal to men with HIV. Research reveals that, across Africa, men have lower rates of HIV testing, enrollment on antiretroviral treatment, adherence, viral load suppression and survival, than […]

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What Future for the ACP-EU Partnership Post-2015?http://www.ipsnews.net/2014/12/what-future-for-the-acp-eu-partnership-post-2015/?utm_source=rss&utm_medium=rss&utm_campaign=what-future-for-the-acp-eu-partnership-post-2015 http://www.ipsnews.net/2014/12/what-future-for-the-acp-eu-partnership-post-2015/#respond Fri, 12 Dec 2014 20:04:37 +0000 Valentina Gasbarri http://www.ipsnews.net/?p=138244 “There are still prospects for a meaningful ACP-EU partnership, capable of contributing and responding concretely and effectively to the objectives of promoting and attaining peace, security, poverty eradication and sustainable development,” according to the top official of the African, Caribbean and Pacific Group of States (ACP). ACP Secretary General Alhaji Muhammad Mumuni was speaking at […]

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The 100th session of the ACP Council of Ministers, held in Brussels from Dec. 9 to 12, discussed prospects for a meaningful partnership with the European Union. Credit: Courtesy of ACP

By Valentina Gasbarri
BRUSSELS, Dec 12 2014 (IPS)

“There are still prospects for a meaningful ACP-EU partnership, capable of contributing and responding concretely and effectively to the objectives of promoting and attaining peace, security, poverty eradication and sustainable development,” according to the top official of the African, Caribbean and Pacific Group of States (ACP).

ACP Secretary General Alhaji Muhammad Mumuni was speaking at the 100th session of the ACP Council of Ministers held here from Dec. 9 to 12, during which ACP and European Union representatives took the opportunity to renew their commitment to working closely together, particularly in crafting a common strategy for the post-2015 global development agenda.

Besides discussing trade issues, development finance, humanitarian crises and the current Ebola crisis, the two sides also tackled future perspectives and challenges for the ACP itself and for its partnership with the European Union.“We must speed up our efforts. 2015 will not be the end of the road. The 2015-post development agenda presents us with the chance to go even further. We can play a role together. This is why the Joint ACP-EU Declaration on the Post-2015 Development Agenda … is so valuable” – European Development Commissioner Neven Mimica

It was agreed that comprehensive cooperation built on collaborative approaches, creative methods and innovative interventions in all the countries of the ACP will be the inspiration for a joint initiative in 2015, in the context of the celebration of the 40th anniversary of the Lomé Convention, the trade and aid agreement between the ACP and the European Community first signed in February 1075 in Lomé, Togo, and the forerunner to the Cotonou Agreement.

The European Union will also be celebrating European Year for Development in 2015, which is also the deadline year for the United Nations’ Millennium Development Goals (MDGs).

The convergence of these three events, and the anticipated adoption by the international community of the development framework which is to replace the MDGs, “together represent a unique opportunity for the ACP and the European Union to demonstrate in a concrete fashion that they have and continue to strive for impactful relations in the future,” said Bhoendratt Tewarie, Minister of Planning and Sustainable Development of Trinidad and Tobago, who chairs the ACP Ministerial Committee on Development Finance Cooperation.

While acknowledging the current economic and financial difficulties being experienced by the European Union and the efforts under way to address them, it was stressed that these do not undermine the validity and strength of the ACP-EU partnership, that the rationale behind the partnership remains valid and that efforts must be redoubled for mutual benefit.

Proof of the commitment to help ACP countries meet the objectives of the Cotonou Agreement was identified in the concrete efforts being undertaken by both sides to improve the quality of life of the most impoverished and vulnerable countries – as  well as other countries, including middle income and upper middle income countries – of the ACP which continue to experience serious developmental challenges.

European Commissioner for International Cooperation and Development Neven Mimica said that the post-2015 development agenda and the post-Cotonou framework – to succeed the current ACP-EC Partnership Agreement signed in Cotonou, Benin, in 2000 – “will shape development policy for the next decade.”

“We can agree on the need for an enhanced approach, building further on our partnership, incorporating overarching principles, such as respect for fundamental values, and taking account of specific realities in countries and regions,” he told the meeting.

The New EU Commission and EDF Programming

The Council of Ministers’ session was also the occasion for ACP members to meet with members of the new European Commission, which took office on Nov. 1, including the High Representative of the European Union for Foreign Affairs and Security Policy, Federica Mogherini, Development Commissioner Mimica as well as European Commissioner for Humanitarian Aid and Crisis Management, Christos Stylianides.

Under the new Commission, the eleventh edition of the European Union’s main instrument for providing development aid to ACP countries, the European Development Fund, has been approved for the period 2014-2020 fora total of 31.5 billion euro, but has not yet entered into force.

Pending a further six ratifications on the European side, which are expected by mid-2015, a “bridging facility” amounting to 1.5 billion euro sourced from unused funds from previous EDFs, will allow priority actions to continue in ACP countries in 2014 and 2015.

To date, 53 national indicative programmes (worth up to 10 billion euro for the period 2014-2020) have been signed, with the remaining programmes to be signed by early 2015.

At the regional level, there is broad agreement on the content – sectors and financial breakdown – of the programmes, which should be signed by the first semester of 2015. The Intra-ACP cooperation strategy will be also be adopted and signed during the first semester of 2015.

“But we must not be complacent,” said Mimica. “We must speed up our efforts. 2015 will not be the end of the road. The 2015-post development agenda presents us with the chance to go even further. We can play a role together. This is why the Joint ACP-EU Declaration on the Post-2015 Development Agenda, which was adopted last June in Nairobi, is so valuable.”

The Joint Declaration represents the springboard for building greater consensus and contributing towards meaningful and ambitious outcomes in July and September next year, looking forward to a post-Cotonou framework.

“Transforming the ACP Group into a Global Player”

Meanwhile, the ACP Group is currently reflecting on its institutional aspects, such as leadership, organizational mandate, and implementation of reforms which aim at making it a more effective and accountable stakeholder in the international political context, while working on reducing poverty and promoting sustainable development in member states.

Newly appointed ACP Secretary General, Ambassador Dr Patrick Gomes from Guyana. Credit: Valentina Gasbarri/IPS

Newly appointed ACP Secretary General, Ambassador Patrick Gomes from Guyana. Credit: Valentina Gasbarri/IPS

An Eminent Persons Group has been established and a report will be presented to the next ACP Summit with the aim of identifying the most suitable strategic approach for ACP to be more effective, more visible, more accountable in a world of partnership and ownership, incorporating overarching principles such as respect for fundamental values and taking into account the specificities of the realities in countries and regions.

An important sign of the ACP institutional change was also launched during the 100th Council of Ministers with the appointment of the new Secretary General, Patrick Gomes, who will head the ACP Secretariat from 2015 to 2020, a landmark period covering the latest part of the ACP partnership agreement with the European Union.

Appointment of the Secretary General generally follows a principle of rotation among the six ACP regions – West Africa (currently holding the post), East Africa, Central Africa, Southern Africa, the Caribbean and the Pacific Islands.

Gomes is the Ambassador of Guyana to the European Union and the Kingdom of Belgium and the country representative to the WTO, FAO, and the IFAD.

Gomes has led various high-level ambassadorial committees in the ACP system, currently serving as Chair of the Working Group on Future Perspectives of the ACP Group, which transmitted a final report on “Transforming the ACP Group into a Global Player” during the ACP Council of Ministers.

(Edited by Phil Harris)

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Starvation Strikes Zimbabwe’s Urban Dwellershttp://www.ipsnews.net/2014/12/starvation-strikes-zimbabwes-urban-dwellers/?utm_source=rss&utm_medium=rss&utm_campaign=starvation-strikes-zimbabwes-urban-dwellers http://www.ipsnews.net/2014/12/starvation-strikes-zimbabwes-urban-dwellers/#comments Tue, 09 Dec 2014 18:51:05 +0000 Jeffrey Moyo http://www.ipsnews.net/?p=138176 As unemployment deepens across this Southern African nation and as the country battles to achieve the United Nations Millennium Development Goals (MDGs) ahead of the December 2015 deadline, thousands of urban Zimbabweans here are facing starvation. The MDGs are eight goals agreed to by all U.N. member states and all leading international development institutions to […]

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Faced with starvation, hordes of jobless Zimbabweans in towns and cities here have turned to vending on streets pavements to put food on their tables. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Dec 9 2014 (IPS)

As unemployment deepens across this Southern African nation and as the country battles to achieve the United Nations Millennium Development Goals (MDGs) ahead of the December 2015 deadline, thousands of urban Zimbabweans here are facing starvation.

The MDGs are eight goals agreed to by all U.N. member states and all leading international development institutions to be achieved by the target date of 2015. These goals range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education.

Zimbabwe has a total population of just over 13 million people, according to the 2012 National Census – of these, 67 percent now live in rural areas while 33 percent live in urban areas.

According to the Poverty, Income, Consumption and Expenditure Survey report for 2011-2012 from the Zimbabwe Statistical Agency (ZIMSTAT), 30.4 percent of rural people in Zimbabwe are “extremely poor” – and are also people facing starvation – compared with 5.6 percent in urban areas.“The current inability of the economy to address people’s basic needs is leading to hunger in most urban households, with almost none of urban residents in Zimbabwe being able to afford three meals a day nowadays” – Philip Bohwasi, chairperson of Zimbabwe’s Council of Social Workers

Social workers find the stay of urban dwellers in Zimbabwe’s cities justifiable, but ridden with hardships.

“Remaining in towns and cities for many here is better than living in the countryside as every slightest job opportunity often starts in urban areas in spite of the expensive living conditions in towns and cities,” independent social worker Tracey Ngirazi told IPS.

According to Philip Bohwasi, chairperson of Zimbabwe’s Council of Social Workers, urban starvation is being caused by loss of jobs – the World Food Programme (WFP) estimates unemployment in Zimbabwe to be at 60 percent of the country’s total population.

“The current inability of the economy to address people’s basic needs is leading to hunger in most urban households, with almost none of urban residents in Zimbabwe affording three meals a day nowadays,” Bohwasi told IPS.

True to Bohwasi’s words, for many Zimbabwean urban residents like unemployed 39-year-old qualified accountant Josphat Madyira from the Zimbabwean capital Harare, starvation has become order of the day.

“Food stores are filled to the brim with groceries, but most of us here are jobless and therefore have no money to consistently buy very basic foodstuffs, resulting in us having mostly one meal per day,” Madyira told IPS.

Madyira lost his job at a local shoe manufacturing company after it shut down operations owing to the country’s deepening liquidity crunch, thanks to a failing economy here that has rendered millions of people jobless.

Asked how city dwellers like him are surviving, Madyira said: “People who are jobless like me have resorted to vending on streets pavements, selling anything we can lay our hands on as we battle to put food on our tables.”

The donor community, which often extends food aid to impoverished rural households, has rarely done the same in towns and cities here despite hunger now taking its toll on the urban population, according to civil society activists.

“Whether in cities or remote areas, hunger in Zimbabwe is equally ravaging ordinary people and most of the donor community has for long directed food aid to the countryside, rarely paying attention to towns and cities, which are also now succumbing to famine,” Catherine Mukwapati, director of the Youth Dialogue Action Network civil society organisation, told IPS.

Apparently failing to combat hunger in line with the MDGs, over the years Zimbabwe has not made great strides in eradicating extreme poverty and hunger due to the economic decline that has persisted since 2000.

As a result, earlier this year, the U.N. Children’s Fund (UNICEF), in partnership with the Zimbabwean government, extended its monthly cash pay-out scheme to urban areas.

Under this scheme, which started at the peak of Zimbabwe’s economic crisis in 2008, families living on less than 1.25 dollars a day receive a monthly pay-out of between 10 and 20 dollars, depending on the number of family members.

Economists and development experts here say that achieving the MDGs without food on people’s tables, especially in cities whose inhabitants are fast falling prey to growing hunger, is going to be a nightmare, if not highly impossible for Zimbabwe.

“Be it in cities or rural areas, Zimbabwe still has a lot of people living on less than 1.25 dollars a day, which is the global index measure of extreme poverty, a clear indication that as a country we are far from successfully combating hunger and poverty in line with the U.N. MDGs whose global deadline for world countries to achieve is next year,” independent development expert Obvious Sibanda told IPS.

According to the 2013 Human Development Index of the U.N. Development Programmer (UNDP), Zimbabwe is a low-income, food-deficit country, ranked 156 out of 187 countries globally and UNDP says that currently 72 percent of Zimbabweans live below the national poverty line.

Although hunger is now hammering people in both urban and rural areas, government sources also recognise that the pinch is being felt more by urban dwellers.

“The decline in formal employment, mostly in towns and cities, with many workers engaged in poorly remunerated informal jobs, has a direct bearing on both poverty and hunger, which is on a sharp rise in urban areas,” a top government economist, who declined to be named, admitted to IPS.

For the many hunger-stricken Madyiras in Zimbabwe’s towns and cities, meeting the MDGS by the end of next year matters little.

“Defeating starvation is far from me without decent and stable employment and whether or not my country fulfils the MDGs, it may be of no immediate result to many people like me,” Madyira told IPS.

(Edited by Phil Harris)

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Marginalised Communities Warn of AIDS/TB “Tragedy” in Eastern Europe and Central Asiahttp://www.ipsnews.net/2014/12/marginalised-communities-warn-of-aidstb-tragedy-in-eastern-europe-and-central-asia/?utm_source=rss&utm_medium=rss&utm_campaign=marginalised-communities-warn-of-aidstb-tragedy-in-eastern-europe-and-central-asia http://www.ipsnews.net/2014/12/marginalised-communities-warn-of-aidstb-tragedy-in-eastern-europe-and-central-asia/#comments Tue, 09 Dec 2014 13:22:20 +0000 Pavol Stracansky http://www.ipsnews.net/?p=138173 Marginalised communities and civil society groups helping them are warning of a “tragedy” in Eastern Europe and Central Asia (EECA) as international funding for HIV/AIDS and tuberculosis (TB) programmes in the regions is cut back. The EECA is home to the world’s only growing HIV/AIDS epidemic and is the single most-affected region by the spread […]

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Young boy sitting on a wall outside 'Way Home', a UNICEF-assisted shelter providing food, accommodation, literacy trainings and HIV/AIDS-awareness lessons to street children in Odessa, Ukraine. Because of unsafe sex and injecting drug use, street adolescents are one of the groups most at risk of contracting HIV. Credit: UNICEF/G. Pirozzi

By Pavol Stracansky
KIEV, Dec 9 2014 (IPS)

Marginalised communities and civil society groups helping them are warning of a “tragedy” in Eastern Europe and Central Asia (EECA) as international funding for HIV/AIDS and tuberculosis (TB) programmes in the regions is cut back.

The EECA is home to the world’s only growing HIV/AIDS epidemic and is the single most-affected region by the spread of multi-drug resistant TB (MDR-TB). For years, HIV/AIDS and TB programmes in many of its countries have been heavily, or exclusively, reliant on funding from theGlobal Fund to Fight AIDS, TB and Malaria.

But this year has seen the Global Fund move to a new financing model based on national income statistics, under which funding in many EECA countries has already been – or will soon be – heavily cut.“This [reduction in Global Fund financing] could lead to tragedy because governments are not yet ready to take on the responsibility for addressing the HIV/AIDS epidemic. I would like decision-makers to understand that this is not just [about] epidemiological statistics but that our lives and health are at stake” – Viktoria Lintsova of the Eurasian Network of People Who Use Drugs (ENPUD)

Some of those likely to be most heavily affected by the cuts say that the reduction in Global Fund financing is putting essential HIV/AIDS and TB services, and with it lives, at risk.

Viktoria Lintsova of the Eurasian Network of People Who Use Drugs (ENPUD) told IPS: “This could lead to tragedy because governments are not yet ready to take on the responsibility for addressing the HIV/AIDS epidemic. I would like decision-makers to understand that this is not just [about] epidemiological statistics but that our lives and health are at stake.”

At the heart of their concerns are worries over funding for not just medical treatment for existing patients but prevention and other services for at risk and marginalised communities.

Injection drug use has been identified as the main driver of the HIV/AIDS epidemic in the EECA but HIV/AIDS is also being increasingly spread among men who have sex with men and sex workers – groups which are heavily marginalised because of political and societal attitudes to homosexuality and women.

TB, an equally severe health problem in the EECA, is closely linked to the HIV/AIDS epidemic because co-infection rates are often high.

Throughout the region, prevention and harm reduction services for marginalised groups are provided by civil society groups which rely almost exclusively on international funding.

Sveta McGill, health advocacy officer at international advocacy NGO Results UK, told IPS that the withdrawal of Global Fund funding could see many sick people slip under the health care radar.

She said: “It is affecting services provided by NGOs covering at-risk groups. These ‘low threshold entry’ services, while not necessarily medical interventions, are crucial to keep people from risk groups coming to centres where they get referred to medical institutions to get treatment and can access medical services as well.

“Often, they would not feel comfortable going straight to state health care institutions, and closing down these venues would mean that less people would be referred to state health care institutions.”

Critics point to rising HIV/AIDS infections in Romania in recent years as a sign of what could happen in other EECA countries when the Global Fund cuts back its financing.

The Global Fund ended financing for programmes in the country in 2010. According to data from the Romanian government, since then there has been a dramatic rise in HIV infections among people who use drugs: in 2013, about 30 percent of new HIV cases were linked to injection drug use compared with just three percent in 2010.

Under the Global Fund’s New Financing Model (NFM), the major change is a reduction in financing to middle income countries. Many EECA countries are now classified as middle income and critics say that while the organisation’s goal of looking to prioritise use of finite resources is sensible, national income data does not always accurately reflect the ability of people to access health care services, nor whether a country has the funds for an adequate disease response.

They point to studies showing disease burdens shifting from low income countries to middle income states, and poverty being greatest in middle income countries. Also, most people living with HIV live in middle income countries.

But some have also dismissed as naive the notion that, as the Global Fund wants, national governments will automatically fill the gap in funding left as the Global Fund cuts back its financing.

Many point to the situation in Ukraine as an example highlighting the problems of the NFM.

According to a report from the Open Society Foundations, Global Fund spending on HIV will drop by more than 50 percent for Ukraine between 2014 and 2015. This includes reductions in unit cost spending for people who use drugs by 37 percent, for sex workers by 24 percent and for men who have sex with men by 50 percent.

Meanwhile, the national HIV prevention budget was slashed by 71 percent in 2014 amid political and economic upheaval.

Lintsova, who lives in central Ukraine, told IPS of the problems drug users are currently facing.

She said that not only are there shortages of the right drugs to treat TB in some parts of the country, but that very few drug users have access to them. Places on opiate substitution treatment (OST) programmes are very limited and waiting times to join them long, sometimes fatally so.

“I know two people who died waiting to get on an OST programme,” she told IPS. “And there are other problems like a lack of needle exchange centres in rural areas, in fact a lack of any harm reduction services in small towns, which leads to high rates of HIV in those places.”

She added that without proper funding, the situation would not improve. “The only solution to these problems is financing,” she said.

But other stakeholders have also privately raised fears that a greater government role in fields such as drug procurement could see authorities looking to save money and procuring larger quantities of cheaper TB drugs of worse quality. Meanwhile, local legislation also makes procurement tenders long and difficult, leading, some health care experts predict, to governments running out of stocks of some essential medicines.

It is unclear how governments will deal with the reduction of Global Fund financing. The transition from Global Fund to domestic funding, although widely announced and anticipated, is not going smoothly in all countries.

Many are often unclear when the Global Fund will actually leave because no straightforward timing plan has been set. There are also specific problems in individual states. In Ukraine, in particular, domestic TB funding has been severely affected by the military conflict, struggling economy and currency fluctuation.

Late last month, these growing fears prompted 24 prominent NGOs in the region to send an open letter to the Global Fund warning of their ‘grave concerns’ over the allocation of funding in the region and calling for it to work with local groups and affected communities.

They specifically asked it to look at each country individually, rather than adopt a “one size fits all” approach.

The Global Fund declined to respond when contacted by IPS.

However, drug users who spoke to IPS said there was little hope of an improvement in the region’s HIV/AIDS and TB epidemics if the Global Fund fails to heed NGOs’ warnings.

Lintsova told IPS: “A lack of reaction to our calls could lead to problems accessing prevention and treatment programmes and a deepening of the EECA’s HIV/AIDS and TB epidemics.”

(Edited by Phil Harris)

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Ebola Overshadows Fight Against HIV/AIDS in Sierra Leonehttp://www.ipsnews.net/2014/12/ebola-overshadows-fight-against-hivaids-in-sierra-leone/?utm_source=rss&utm_medium=rss&utm_campaign=ebola-overshadows-fight-against-hivaids-in-sierra-leone http://www.ipsnews.net/2014/12/ebola-overshadows-fight-against-hivaids-in-sierra-leone/#respond Mon, 01 Dec 2014 23:55:06 +0000 Lansana Fofana http://www.ipsnews.net/?p=138045 The outbreak of the deadly Ebola epidemic in Sierra Leone has dwarfed the campaign against HIV/AIDS, to the extent that patients no longer go to hospitals and treatment centres out of fear of contracting the Ebola virus. “It is a big challenge for us. HIV/AIDS patients now fear going to hospitals for treatment and our […]

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A billboard in Freetown, Sierra Leone, urging people to go to hospital to be tested for HIV. Ebola has stopped people from doing that. Credit: Lansana Fofana/IPS

By Lansana Fofana
FREETOWN, Dec 1 2014 (IPS)

The outbreak of the deadly Ebola epidemic in Sierra Leone has dwarfed the campaign against HIV/AIDS, to the extent that patients no longer go to hospitals and treatment centres out of fear of contracting the Ebola virus.

“It is a big challenge for us. HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected,” Abubakar Koroma, Director of Communications at the National AIDS Secretariat, told IPS.“HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected” – Abubakar Koroma, Director of Communications, Sierra Leone’s National AIDS Secretariat

Sierra Leone records one of the lowest HIV/AIDS prevalence rates in the West African region. For over five years, the country has managed to stabilise the figures at 1.5 percent, out of a population of 6 million, mainly because of massive countrywide awareness raising. The authorities also offer free medicines and treatment to people living with HIV/AIDS.

But all this may be reversed if the Ebola crisis is not contained soon.

Before the outbreak of the Ebola crisis in Sierra Leone in April, one key area of success in the fight against HIV/AIDS had been in curtailing mother-to-child transmission. Today, however, there are concerns that it may surge again because pregnant women are now reluctant to go to hospitals for treatment.

In 2004, the prevalence rate among pregnant women was 4.9 percent but, just before the Ebola in April this year, the figure had dropped to 3.2 percent.

According to Koroma, “between January and now, that service [for pregnant women] has dropped by 80 percent. We are worried that the Ebola crisis may worsen the situation.” From the point of view of those already living with HIV/AIDS, this is already happening.

Idrissa Songo, Executive Director of the Network of HIV Positives in Sierra Leone (NETHIPS) advocacy group, says that its members fear going to hospitals for care and treatment and that they are constrained by what he described as a cut in the support they were receiving from donors and humanitarian organisations before the outbreak of Ebola.

“Donors and other philanthropists have turned their attention away from the fight against HIV/AIDS,” he said. “Now it’s all about Ebola. Most organisations have diverted their funding to the fight against Ebola and this is badly affecting our activities.”

Songo added that the core activities of NETHIPS, which include community awareness raising and training of members in care and prevention, have all come to a standstill because of the government’s ban on all public gatherings following the Ebola outbreak.

Given the current crisis, the National Aids Secretariat and the Ministry of Health have set up telephone hotlines to connect with people suffering from HIV/AIDS. The aim is to be able to trace and locate them and then get treatment to them. At the same time, HIV/AIDS patients are now receiving a quarterly supply of the drugs they need, compared with the monthly dosage they were receiving before Ebola struck.

According to Songo, these measures are working because “that way, our members, who fear going to hospitals and treatment centres, can stay at home and take their medication. We know it is risky to go to treatment centres nowadays because of the possibility of contracting Ebola, another killer disease,” Songo told IPS.

Notwithstanding the Ebola crisis, Ministry of Health officials say that they have not lost sight of the fight against HIV/AIDS.

Jonathan Abass Kamara, Public Relations Officer at the Ministry of Health, told IPS that attention is still focused on the fight against HIV/AIDS. “Even though Ebola has taken centre-stage, the Ministry is still very much focused on the fight against HIV/AIDS. We supply drugs to patients regularly and we try our best to give care and attention to them,” Kamara told IPS.

However, while Sierra Leone has made tremendous progress in the fight against HIV/AIDS and its success in this fight surpasses that of almost all countries in the West Africa region, it may well find it difficult to maintain its achievements in this sector if the Ebola epidemic is not brought under control.

(Edited by Phil Harris)

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HIV Prevention is Failing Young South African Womenhttp://www.ipsnews.net/2014/12/hiv-prevention-is-failing-young-south-african-women/?utm_source=rss&utm_medium=rss&utm_campaign=hiv-prevention-is-failing-young-south-african-women http://www.ipsnews.net/2014/12/hiv-prevention-is-failing-young-south-african-women/#respond Mon, 01 Dec 2014 13:07:39 +0000 Nqabomzi Bikitsha http://www.ipsnews.net/?p=138030 When she found out that she had human immunodeficiency virus (HIV), Thabisile Mkhize (not her real name) was scared. She knew little about the virus that had been living in her body since birth and did not know whom to ask. Her mother had just died and she lived with her grandmother in rural KwaZulu Natal, […]

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Gender inequalities drive the disproportionate rate of HIV infection among young South African women aged 15 to 24. Credit: Mercedes Sayagues/IPS

By Nqabomzi Bikitsha
JOHANNESBURG, Dec 1 2014 (IPS)

When she found out that she had human immunodeficiency virus (HIV), Thabisile Mkhize (not her real name) was scared.

She knew little about the virus that had been living in her body since birth and did not know whom to ask. Her mother had just died and she lived with her grandmother in rural KwaZulu Natal, where the HIV prevalence is the highest in South Africa, at 17 percent.

Today, at the age of 16,  Mkhize is an enthusiastic peer educator at her school,  discussing HIV prevention, safe sex and sexual rights. “I want young women to be safe, to make healthy sexual choices,“ she told IPS.South Africa has a perfect storm of early sexual debut, inter-generational sex, little HIV knowledge, violence, and gender and economic inequalities that lead young women aged between 15 and 24 to have a disproportionately high rate of HIV infection

South Africa has a perfect storm of early sexual debut, inter-generational sex, little HIV knowledge, violence, and gender and economic inequalities that lead young women aged between 15 and 24 to have a disproportionately high rate of HIV infection.

They account for one-quarter of new HIV infections and 14 percent of the country’s 6.4 million people living with HIV, according to the ‘South African National HIV Prevalence, Incidence and Behaviour Survey’.

Alarmingly, HIV incidence – the number of new  infections per year – among women aged between 15 and 24 is more than four times higher than among their male peers.

Professor Sinead Delany-Moretlwe, director for research at Wits Reproductive Health and HIV Institute (Wits RHI) in Johannesburg, describes the factors that put young women at higher risk.

“Structural drivers – gender, social and economic inequalities – interact in a number of ways and influence behaviour such as choice of sexual partner and condom use,” she said.

Explaining that young women find it difficult to protect themselves against HIV, she noted that they “end up with controlling partners and fail to negotiate condom use or are forced to have sex.”

Tumi Molebatse, a 20-year-old student from Soweto, is an example. Years ago she had an HIV test and would like to have another with her boyfriend of two years, or at least to have safe sex.  “But my boyfriend will think I am cheating on him if I ask for condoms,” she told IPS.  “He supports me financially so it’s better to not bring it up.”

FAST FACTS ABOUT HIV IN SOUTH AFRICA

• 6.3 million people live with HIV
• 469,000 total new HIV infections per year
• 113,000 new HIV infections per year among women 15-24
• 11% HIV prevalence among girls aged 15-24
• 32% HIV prevalence among black African women aged 20-34
• 72% of women aged 25-49 have tested for HIV

Source: South African National HIV Prevalence, Incidence and Behaviour Survey.
Molebatse’s dilemma is one familiar to many young women who feel powerless to request the use of condoms or for their partner to test for HIV.

In South Africa, one of the most unequal countries in the world, relationships with older men often pen the way for young women’s social mobility and material comfort.

According to Kerry Mangold from the South African National AIDS Council, inter-generational and transactional sex increase the risk of infection because older men have higher HIV rates than young men.

“It’s not rare to see a young girl sleep with an older man for food or a little bit of money,“ said Mkhize. “Young women aspire to have nice things in life but they don’t have money, they don’t have jobs, and they go for partners who can provide those things.”

According to the ‘South African National HIV Prevalence, Incidence and Behaviour Survey’, one-third of girls aged between 15 and 19 reported a partner five years or more their senior.

Risk and choices

“At its most extreme, gender inequality manifests as gender-based violence,” says Delany-Moretlwe.

In South Africa, young women who experienced intimate partner violence were 50 percent more likely to have acquired HIV than women who had not suffered violence, according to the UNAIDS Gap Report.

Despite decades of awareness campaigns, less than one-third of young women know how to prevent HIV.

Mkhize says that many girls hear about sex and HIV from friends and teachers, and often  the information is wrong. “I know girls who believe you cannot get HIV if you boyfriend has just come back from circumcision school and so they have sex without a condom,” she told IPS.

Mangold would like to see “an enabling environment for young women to make their own choices and reduce their risk.”

Since last year, the ZAZI initiative has been trying to do just that. A sassy campaign, ZAZI (from the Nguni words for “know yourself”) builds knowledge around sexual health through social media, video clips, poetry readings, street murals, music and fun activities that boost girls’ sense of self-worth.

“We hope to discourage them from opting for relationships with older men for material gain and give them confidence to negotiate condom use,” ZAZI advocacy manager Sara Chitambo told IPS.

ZAZI’s motto is “finding your inner strength”. On its website, girls can look up practical advice on what to do if they are raped, where to find contraception and how to prevent HIV.

(Edited by Mercedes Sayagues and Phil Harris)

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AIDS Is No. 1 Killer of African Teenagershttp://www.ipsnews.net/2014/11/africa-aids-is-no-1-killer-of-teenagers/?utm_source=rss&utm_medium=rss&utm_campaign=africa-aids-is-no-1-killer-of-teenagers http://www.ipsnews.net/2014/11/africa-aids-is-no-1-killer-of-teenagers/#respond Fri, 21 Nov 2014 12:02:19 +0000 Sam Olukoya http://www.ipsnews.net/?p=137909 Two years ago, Shola* was kicked out of the family house in Abeokuta, in southwestern Nigeria, after testing HIV-positive at age 13. He was living with his father, his stepmother and their seven children. “The stepmother insisted that Shola must go because he is likely to infect her children,” Tayo Akinpelu, programme director of Youth’s Future […]

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As AIDS becomes the leading cause of death of adolescents in Africa, empowering youth – especially girls - to make safe life choices and avoid HIV is crucial. Credit: Mercedes Sayagues

As AIDS becomes the leading cause of death of adolescents in Africa, empowering youth – especially girls - to make safe life choices and avoid HIV is crucial. Credit: Mercedes Sayagues

By Sam Olukoya
LAGOS, Nigeria, Nov 21 2014 (IPS)

Two years ago, Shola* was kicked out of the family house in Abeokuta, in southwestern Nigeria, after testing HIV-positive at age 13. He was living with his father, his stepmother and their seven children.

“The stepmother insisted that Shola must go because he is likely to infect her children,” Tayo Akinpelu, programme director of Youth’s Future Savers Initiative, told IPS.

SNAPSHOT: ADOLESCENTS WITH HIV IN TANZANIA
In Tanzania, alarmingly, HIV prevalence has not decreased among adolescents aged 15-19 between 2007 and 2012.
An estimated 165,000 adolescents live with HIV, of whom 97,000 girls and 68,000 boys. Some were born with HIV and others contracted it as children or teens.
To better understand their needs, the Tanzania Commission for AIDS conducted a survey of HIV positive teenagers aged 15-19 in seven regions.
Among its findings:

• Four in ten were sexually active, mostly with a regular partner.
• Just a little more than half reported using condoms at last sex.
• A third reported they had experienced sexual violence. Few had discussed the abuse with friends or relatives or reported it to authorities.
• Just over one-third were aware of family planning and child protection services
The study urges delivering information about child protection and sexual and reproductive health services to teens living with HIV so they can make safe life choices and access care and support.
National HIV prevalence is five percent, according to UNAIDS.
Akinpelu turned to Shola’s mother, who had remarried. But she refused, arguing that his father should be responsible for their son.

“Shola felt as an outcast,” says Akinpelu. Eventually, Shola’s grandparents took him in.

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the leading cause of death among adolescents.

“This is absolutely unacceptable,” says Craig McClure, chief of HIV programmes with the United Nations Children’s Fund (UNICEF), in New York. “What’s more, AIDS-related deaths are decreasing for all age groups except adolescents.”

The global AIDS death toll fell by 30 percent between 2005 and 2012 but increased by 50 percent among adolescents, says a UNICEF report.

Fear of seeking help

One reason for this shocking teen death toll, says Dr. Arjan de Wagt, chief of HIV/AIDS with UNICEF in Abuja, is the low number of adolescents on antiretroviral treatment (ART).

Of the 3.1 million Nigerians living with HIV, half are under 24 years. But only two out of ten HIV positive youth over 15 and just one out of ten under 15 received the lifesaving drugs in 2013, de Wagt told IPS.

Rejection by family and society, as happened to Shola, or fear of rejection, prevents adolescents from seeking help.

“Many HIV positive adolescents are dying in silence because they are too ashamed to access treatment,”’ Blessing Uju, a Lagos-based youth counsellor, told IPS.

“The shame is even bigger for the girls. In Nigeria, if you are HIV positive, the impression is that you are a commercial sex worker,” she says.

Sally* did not tell her parents or siblings when she tested HIV positive four years ago, at age 19.

“At the family level, there is a lot of stigma,” she told IPS.

Although aware of the danger of not taking her medication regularly, Sally often skipped it to avoid being seen with pills at home.

“As a young person, you need a confidant. If you are not strong, you might end up taking your life,” she says.

Teenagers need family help to stay on ART, says Akinpelu.

Shola’s grandparents would normally cook the first meal for the day in the afternoon until Akinpelu explained to them that the pills can cause nausea on an empty stomach and Shola needed a hearty meal earlier.

Uju says that treatment fatigue hits adolescents hard. “Some say they prefer to die than to continue taking their drugs,” she says.

adolescents_graph_unaids

High death toll

Of the 2.1 million adolescents living with HIV worldwide in 2012, more than 80 per cent are in sub-Saharan Africa, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Malawi, with 93,000 HIV positive teenagers, has 6,900 annual AIDS-related adolescent deaths.

The death toll is linked to late diagnosis and starting ART too late, explains Judith Sherman, of UNICEF in Lilongwe.

Malawi’s policy is that all children seen in health facilities should be offered an HIV test. “Unfortunately, this does not happen routinely,” she says.

FAST FACTS

AIDS DEATHS AMONG ADOLESCENTS IN 2013


• South Africa 11,000
• Tanzania 10,000
• Ethiopia 7,900
• Kenya 7,800
• Zimbabwe 6,500
• Uganda 6,300
• Malawi 5,600
• Zambia 4,400
• Mozambique 3,900
• Rwanda 1,200
• Lesotho 1,200

Teenagers’ adherence to ART is lower than adults, says Sherman, “for a range of reasons like treatment fatigue, depression, fear of stigma, denial and unstable family relationships.”

Tanzania’s estimated 165,000 adolescents living with HIV face similar challenges as their peers in Nigeria and Malawi. (see sidebar)

Allison Jenkins, chief of HIV/AIDS with UNICEF in Tanzania, says that one effective way to help teenagers are clubs.

“Teen clubs improve adherence to treatment, especially among members who attend regularly,” she told IPS.

HIV among teen girls

Alarmingly, adolescent HIV prevalence is highly gendered, with teen girls showing infection rates that UNAIDS calls ”unacceptably high”.

Teen girls aged 15-19 in Mozambique have a prevalence of seven per cent, more than double the boys of the same age. Botswana presents a similar scenario.

Lucy Attah, of the Lagos-based Women and Children Living with HIV & AIDS, blames poverty.

“Girls have to trade sex for money to sustain themselves,” she says. “The pressure for money is higher in the cities where teenage girls compete to get the best mobile phones and clothes.”

Adolescents become sexually active, try drugs and alcohol, feel invulnerable, and experience the social and economic pressures of becoming an adult. HIV and the lack of youth-friendly health services compound the problem, says the UNICEF report.

 “We must do more and do it well, focusing on sub-Saharan Africa and on adolescent girls, where the heaviest burden lies,” says McClure.

*names changed to protect privacy

Edited by Mercedes Sayagues

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War-ravaged South Sudan Struggles to Contain AIDShttp://www.ipsnews.net/2014/11/war-ravaged-south-sudan-struggles-to-contain-aids/?utm_source=rss&utm_medium=rss&utm_campaign=war-ravaged-south-sudan-struggles-to-contain-aids http://www.ipsnews.net/2014/11/war-ravaged-south-sudan-struggles-to-contain-aids/#respond Fri, 14 Nov 2014 07:01:03 +0000 Charlton Doki http://www.ipsnews.net/?p=137757 Dressed in a flowered African print kitenge and a blue head scarf, Sabur Samson, 27, sits pensively at the HIV centre at Maridi Civil Hospital in South Sudan’s Western Equatoria state.  Today she paid 20 South Sudanese pounds (about six dollars) for a bodaboda (motorbike taxi) ride to the centre and will have to skimp […]

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Displaced women flee fighting by boat to Mingkaman, Awerial County, Lakes State, South Sudan.. Only one out of 10 HIV positive mothers can get the drugs needed to avoid infecting her baby. Credit: Mackenzie Knowles-Coursin/IPS

By Charlton Doki
JUBA, Nov 14 2014 (IPS)

Dressed in a flowered African print kitenge and a blue head scarf, Sabur Samson, 27, sits pensively at the HIV centre at Maridi Civil Hospital in South Sudan’s Western Equatoria state. 

Today she paid 20 South Sudanese pounds (about six dollars) for a bodaboda (motorbike taxi) ride to the centre and will have to skimp on food in the next days.

South Sudan at a quick glance

After four decades of on-off war, South Sudan gained independence from north Sudan in July 2011. But stability did not last long.

Violence rooted in political and ethnical power struggles erupted in December 2013, shattering the dreams of peace for the world’s newest country (pop 11.3m).

After independence, South Sudan improved services for its estimated 150,000 people living with HIV. The new conflict reversed these gains, disrupting not only health services but water and sanitation, roads and bridges, food security and community networks.

The United Nations estimates that 1.9 million people are newly displaced. Some fled to neighbouring countries, while 1.4 million huddle in 130 camps in South Sudan. Of these, 70 are so remote they are inaccessible to relief agencies, says a study by the HIV/AIDS Alliance.

South Sudan has limited human resources, organisational and technical capacity to respond to HIV, says the study.

Key drivers of the HIV epidemic in South Sudan include early age at first sex, low level of knowledge about HIV and of condom use, rape and gender-based sexual violence, high rate of sexually transmitted diseases and stigma.

The highest HIV prevalence is found in the three southern Greater Equatoria states bordering Uganda and the Democratic Republic of Congo. In Western Equatoria, where Samson and Mongo live, HIV prevalence is seven percent, more than double the national rate.

She will be hungry and few will help her in the village, although she is blind and a single mother of two children.

“Many people fear to come close because they fear they will contract HIV,” she told IPS.

Seated next to her, Khamis Mongo, 32, has lived with HIV for five years now and has suffered similar rejection. “Some people don’t want to eat from the same plate with me,” he says.

Mongo and Samson are among nearly 1,000 HIV positive people receiving care at the centre, of whom 250 are in antiretroviral therapy (ART). They are lucky: in South Sudan, just one out of 10 people needing ART gets it.

The clinic sees patients coming from as far as 100 kilometres.

“So many patients are dying because they can’t afford transport to collect their medicine here,” clinical officer Suzie Luka told IPS.

A one-way, 80 km bodaboda trip from Ibba to Maridi costs 150 South Sudanese pounds (47 dollars).

The challenges in Maridi are a microcosm of those that the world’s newest country, South Sudan, faces in containing the HIV epidemic.

Newly independent from north Sudan in 2011, and emerging from Africa’s longest civil war over 21 years with one of the world’s lowest human development statistics, South Sudan plunged again into fighting in December 2013.

The national HIV prevalence rate is under three percent and rising steadily, according to the Joint United Nations Programme for HIV/AIDS (UNAIDS).

This translates into 150,000 people living with HIV in a country whose social fabric and physical infrastructure was destroyed by successive wars.

 “Moving corpses”

Evelyn Letio, from the South Sudan Network of People Living with HIV, describes poor access, quality and continuity of health services, underpinned by denial of the disease and high stigma and discrimination, especially against women.

“Community leaders will hurriedly accept a divorce if it’s the woman who is positive and force her to leave the man’s house,” says Letio.”If it’s the man who is positive, they won’t allow the woman to leave the house so she can take care of him.”

Despite denial by government officials, discrimination is rampant within the civil service, she adds:  “People who have disclosed to be HIV positive are laid off and called ’moving corpses’.”

Inadequate financial, infrastructural and human resources limit efforts to expand HIV services.  The national HIV plan has an 80 percent funding shortfall.

Mongo and Sanson told IPS that the Maridi clinic often runs out of drugs and they have to return days later. Other times, staff has not been paid for months and stays away.

“Treatment has been tricky,” acknowledges Habib Daffalla Awongo, director general for programme coordination at South Sudan AIDS Commission.

According to UNAIDS, just 22 centres provided ART before the new outbreak of violence.

Last December, the ART centres in Bor, Malakal and Bentiu, capitals of the states worst hit by fighting, had to close. The whereabouts of 1,140 patients are unknown. Most likely they have interrupted ART, endangering their lives.

War and AIDS

Forty thousand people living with HIV have been directly affected by the recent violence, according to the United Nations. The new fighting reversed the gains made in HIV services since independence. 

Fast Facts About AIDS in South Sudan

150,000 people live with HIV
20,000 children under 15 live with HIV
12.500 AIDS-related deaths in 2013
15,400 new infections in 2013
72,000 people need ART
1 in 10 people needing ART is on ART
1 in 10 HIV positive pregnant women is on PMTCT
27 percent of people over 15 years are literate
1.9m internally displaced people in 2014

“We have lost many HIV positive people during the conflict, some died in the fighting and others migrated to peaceful areas,” said Awongo.

By U.N. counts,  the new conflict has displaced 1.9 million people.

In Juba, the capital, camps with long rows of white tents have sprung up to shelter some 31,000 displaced people.

Among them is Taban Khamis*, who escaped fighting in the key oil city of Bentiu, 1,000 kms north of Juba. He has interrupted ART and fears his health will soon worsen but he will not go to the camp’s HV clinic for fear of stigma.

“The camp is crowded and there is no privacy,” he told IPS. “Everyone will know that I have HIV.”

Prevalence of HIV and sexually transmitted infections “dramatically increases in camps”, says a study by the HIV/AIDS Alliance.

Awongo is aware of this problem. “We encourage people to come out of the camps to facility points where they can access services but this is not making a difference,” he says.

*Name changed to protect his privacy

Edited by: Mercedes Sayagues

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The Young, Female Face of HIV in East and Southern Africahttp://www.ipsnews.net/2014/11/the-young-female-face-of-hiv-in-east-and-southern-africa/?utm_source=rss&utm_medium=rss&utm_campaign=the-young-female-face-of-hiv-in-east-and-southern-africa http://www.ipsnews.net/2014/11/the-young-female-face-of-hiv-in-east-and-southern-africa/#comments Fri, 07 Nov 2014 07:24:48 +0000 Miriam Gathigah http://www.ipsnews.net/?p=137644 Experts are raising alarm that years of HIV interventions throughout Africa have failed to stop infection among young women 15 to 24 years old. “Prevention is failing for young women,” says Lillian Mworeko, HIV expert with International Community of Women Living with HIV in Eastern Africa, based in Uganda. Among women in East and Southern […]

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Gender inequalities explain why prevention is failing to contain HIV infection among young women in East and Southern Africa. UNAIDS calls for a major effort to reduce their risk of infection. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Nov 7 2014 (IPS)

Experts are raising alarm that years of HIV interventions throughout Africa have failed to stop infection among young women 15 to 24 years old.

“Prevention is failing for young women,” says Lillian Mworeko, HIV expert with International Community of Women Living with HIV in Eastern Africa, based in Uganda.

Among women in East and Southern Africa, four out of ten new HIV infections among women aged 15 years and over happen among  those aged 15 to 24, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Worryingly, HIV infection rates among young women are double or triple those of their male peers. In South Africa, the HIV prevalence of 18 percent among women aged 20-24 is three times higher than in men of the same age. 

The failure of prevention: young women and HIV in East and Southern Africa

In Lesotho, HIV prevalence of four percent among adolescent girls rises four-fold by the time they are 24.

In Botswana, the number of women newly infected with HIV (6,200 in 2012) has only declined by 14 percent since 2009.

The age of consent for marriage is 15 years in Malawi and Tanzania.

Nearly half of all girls in Malawi are married by age 19.

In South Africa, within the 25- 29 year age group, HIV prevalence among women is 28% and 17% among men (UNFPA)

In Tanzania, young women are almost three times more likely to be HIV positive than young men

In Malawi, the number of women acquiring HIV has not decreased since 2009, at 29,000 per year.

In Tanzania, HIV prevalence jumps from one percent among girls under 17 years old to 17 percent by age 24.

In Sub-Saharan Africa, adolescent and young women account for one in four new infections.

Source: UNAIDS

Equally alarming are surveys showing that fewer than two in ten young women know their HIV status.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, limited access to health care, education and jobs, and health systems that do not address the needs of youth.

Biology does not help. Teenage girls’ immature genital tract is more prone to abrasions during sex, opening entry points for the virus, Dr Milly Muchai told IPS.

Muchai, a reproductive health expert in Kenya, says it is not just sex that drives HIV infections among young women but the age of the male sexual partner.

“The risk increases steadily with male partners aged 20 years and over,” she explains.

Older men are more likely to have HIV than teenage boys. The Kenya AIDS Indicator Survey 2012 shows that male HIV prevalence remains low and stable until the age of 24, when it shoots up significantly.

Due to intergenerational sex, women in this region are acquiring HIV five to seven years earlier than men, says Muchai, because these relationships are characterised by multiple sexual partners and low condom use. In transactional sex, the young woman receiving gifts or money loses power to negotiate safe sex.

But Kenya is not a unique scenario.

Shocking figures

In Swaziland, Lesotho and Botswana, more than one in 10 females aged 15 to 24 are living with HIV, according to UNAIDS.

Dr Gang Sun, UNAIDS country director in Botswana, says that, in spite of the country’s remarkable progress in reduction of new infections and treatment, HIV is still a girls’ and women’s epidemic due to gender inequality and unequal power dynamics.

Among Batswana youth aged 20 to 24 years, HIV infection among women triples that of men, nearly 15 percent compared to 5 percent, he says.

Mary Pat Kieffer, senior director at Elizabeth Glaser Paediatric AIDS Foundation in Malawi, told IPS that as teenage girls become older, the risk of infection rises.

In Swaziland, HIV prevalence is six percent for girls aged 15 to 17 but rises to a whopping 43 percent by age 24.

Source: UNICEF

Source: UNICEF

A package of interventions

Kieffer says that many of the issues – poverty, lack of secondary education, few jobs, rape and intimate partner violence – that underpin the unacceptably high HIV prevalence among young women are bigger than what HIV programs alone can address.

Mworeko observes major gaps in reproductive and sexual health services for young people, when they are neither children nor adults, in the region.

“Whether it is prevention, treatment, care and support services, young people do not have a youth friendly corner,” she says.

Paska Kinuthia, youth officer with UNAIDS in South Africa, told IPS that sexuality education needs to be strengthened in schools across the region.

“The regional average of comprehensive knowledge of HIV and AIDS stands at 41 percent for young men and 33 percent for young women,” he says.

Experts agree there is no one single solution to protect young women and a combination of interventions is needed.

Addressing restrictive laws on the age of consent for HIV testing and for access to sexual and reproductive health services would be a good place to start, experts say.

Promoting gender equality and providing jobs for young people are part of the solution, says Sun.

In Tanzania, HIV infection among girls more than triples between 15-19 and 20-24 years.

This fact, says Allison Jenkins, chief of HIV/AIDS with the United Nations Children’s Fund in Dar es Salaam, underlines “the importance of orienting HIV prevention and economic livelihoods interventions during her transition to adulthood.”

For all these reasons, UNAIDS is calling for “a major movement to protect adolescent girls and young women from HIV infection.”

Edited by: Mercedes Sayagues

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Mozambique Tackles its Twin Burden of Cervical Cancer and HIVhttp://www.ipsnews.net/2014/10/mozambique-tackles-its-twin-burden-of-cervical-cancer-and-hiv/?utm_source=rss&utm_medium=rss&utm_campaign=mozambique-tackles-its-twin-burden-of-cervical-cancer-and-hiv http://www.ipsnews.net/2014/10/mozambique-tackles-its-twin-burden-of-cervical-cancer-and-hiv/#respond Fri, 31 Oct 2014 05:27:07 +0000 Mercedes Sayagues http://www.ipsnews.net/?p=137498 The woman on bed 27 in Maputo Central Hospital’s oncology ward has no idea how lucky she is. In January, when abdominal pains racked her, a pharmacist suggested pain killers. For months, “the pain would go and return,” she told IPS.  In April she went to the local clinic in Matola, 15kms from Mozambique’s capital, […]

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Fighting the “Neighbour’s Disease” in Mozambiquehttp://www.ipsnews.net/2014/10/fighting-the-neighbours-disease-in-mozambique/?utm_source=rss&utm_medium=rss&utm_campaign=fighting-the-neighbours-disease-in-mozambique http://www.ipsnews.net/2014/10/fighting-the-neighbours-disease-in-mozambique/#respond Fri, 31 Oct 2014 05:26:50 +0000 Mercedes Sayagues http://www.ipsnews.net/?p=137494 Mozambique is reeling under the twin burden of HIV and cervical cancer. Eleven women die of cervical cancer every day, or 4,000 a year. Yet this cancer is preventable and treatable, if caught early. Among African countries, Mozambique vies neck and neck with Malawi for the saddest statistics. Mozambique has the highest cervical cancer cumulative […]

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Every day, eleven Mozambican women die of cervical cancer. That is 4,000 every year. It is the most frequent cancer among women aged 15-44 and the biggest killer of women among all cancers. Credit: Mercedes Sayagues/IPS

Every day, eleven Mozambican women die of cervical cancer. That is 4,000 every year. It is the most frequent cancer among women aged 15-44 and the biggest killer of women among all cancers. Credit: Mercedes Sayagues/IPS

By Mercedes Sayagues
MAPUTO, Oct 31 2014 (IPS)

Mozambique is reeling under the twin burden of HIV and cervical cancer. Eleven women die of cervical cancer every day, or 4,000 a year. Yet this cancer is preventable and treatable, if caught early.

Among African countries, Mozambique vies neck and neck with Malawi for the saddest statistics.

Mozambique has the highest cervical cancer cumulative risk and mortality – seven out of 100 newborn girls will develop this cancer and five will die from it.

Malawi is first in incidence (new cases per year), with Mozambique tailing second.

Cervical cancer is caused by the Human Papilloma Virus (HPV), a common virus with 40 types. Many people carry it dormant and often it goes away by itself. But two types of HPV cause cervical cancer.

HIV and HPV are deadly allies. HPV infection doubles the risk of acquiring HIV while HIV hastens progression of cervical cancer.

Some numbers will give an idea of Mozambique’s burden:

  • 7.3 million women over age 15, who can potentially acquire HPV through sex.
  • 820,000 women over age 15 living with HIV. Cervical cancer advances quickly with a weak immune system.
  • 4,000 deaths of cervical cancer a year, not counting those who die at home, undiagnosed, untreated and unreported

Step by step, health authorities are tackling the problem with a three-pronged strategy: information for prevention, routine screening for detection, and better treatment.

There is even talk of bringing radio therapy equipment and training technicians. In terminal stages, radio therapy shrinks cancer and reducing excruciating pain.

Routine screening for this cancer is now offered with family planning services. Diagnosis and treatment via cryotherapy (freezing) can be done in one visit. The Ministry of Health hopes to cover all districts by 2017.

The mass media campaign had a tireless advocate in the former First Lady, Maria da Luz Guebuza. The Association for the Fight against Cancer, a volunteer group, has multiplied its outreach and helps patients at the oncology wards of main hospitals.

Information is dispelling the perception of cervical cancer as “the neighbour’s disease”, brought upon women by a neighbour’s curse or by witchcraft.

The situation is still dire; needs outpace resources, both human and financial. But it is a great improvement over just three years ago, when only a handful of clinics offered screening, and millions of women had never heard about HPV and cervical cancer at all.

 

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Writing the Final Chapter on AIDShttp://www.ipsnews.net/2014/10/writing-the-final-chapter-on-aids/?utm_source=rss&utm_medium=rss&utm_campaign=writing-the-final-chapter-on-aids http://www.ipsnews.net/2014/10/writing-the-final-chapter-on-aids/#comments Fri, 17 Oct 2014 06:50:55 +0000 Miriam Gathigah http://www.ipsnews.net/?p=137230 Although AIDS has defied science by killing millions of people throughout Africa in the last three decades, HIV experts now believe that they have found the magic numbers to end AIDS as a public health threat in 15 years. The magic numbers are 90-90-90 and are informed by growing clinical evidence showing that HIV treatment […]

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Testing, treating and suppressing viral load in massive numbers could curb the spread of AIDS by 2020. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Oct 17 2014 (IPS)

Although AIDS has defied science by killing millions of people throughout Africa in the last three decades, HIV experts now believe that they have found the magic numbers to end AIDS as a public health threat in 15 years.

The magic numbers are 90-90-90 and are informed by growing clinical evidence showing that HIV treatment equals prevention because putting people on antiretroviral therapy (ART) reduces new infections.

The new treatment targets seek that, by 2020:

  • 90 percent of people living with HIV get diagnosed
  • 90 percent of people diagnosed with HIV will be on ART
  • 90 percent of people on ART achieve durable viral suppression

The 90-90-90 plan, unveiled by the Joint United Nations Programme on HIV/AIDS (UNAIDS) earlier this year, seeks to halt the spread of HIV by 2020 and to end the epidemic by 2030.

While this is the most ambitious strategy to eliminate HIV yet, experts such as Dr Lucy Matu, director of technical services at the Elizabeth Glaser Paediatric AIDS Foundation in Kenya, says that it can be done.

She told IPS that in Kenya 72 percent of the estimated total number of people living with HIV have been tested, and 76 percent of the 880,000 adults and children diagnosed with HIV were on ART by April 2014.

Kenya will get closer to the 90-90-90 target as it implements the 2013 World Health Organisation (WHO) guidelines, which increased the CD4 count threshold to start ART from 350 to 500, says Matu.

As eligibility for ART becomes broader, she explains, “it will push the number of people on ART up by at least 250,000 to 300,000 to at least 90 percent of those in care, and of course more people will continue to enroll in care.”

An attainable goal

The WHO guidelines build on the clinical benefits of starting ART earlier. Patients stay healthier and avoid opportunistic infections, such as pneumonia, meningitis and TB.

Kenya is not the only country on track to achieving the ambitious 90-90-90 targets. In Botswana, which has a very high adult HIV prevalence, surpassed only by Swaziland globally, more than 70 percent of people living with HIV are on ART.

All East and Southern African countries are adopting the new guidelines, says Dr Eleanor Gouws-Williams, senior strategic information adviser with UNAIDS.

Rwanda, Uganda, Zambia, Malawi and Swaziland are “finalising their national guidelines while others like South Africa are planning to implement the new guidelines next year,” she told IPS.

Gouws-Williams believes that the 90-90-90 plan is attainable.

90-90-90: the formula that experts believe could write the final chapter on AIDS in 15 years. Courtesy: UNAIDS

90-90-90: the formula that experts believe could write the final chapter on AIDS in 15 years. Courtesy: UNAIDS

Testing is the first step

Only half of all people living with HIV in sub-Saharan Africa have been diagnosed, says UNAIDS, so getting them to test is the first step.

Studies in Kenya and Uganda show that including HIV testing in multi-disease campaigns drove coverage up by 86 percent and 72 percent respectively.

But experts caution that the targets are more than putting loads of people on ART. Attaining viral suppression is key.

“In Rwanda, 83 percent of people receiving ART were found to be virally suppressed after 18 months of therapy,” says Gouws-Williams.

In Zimbabwe, Dr Agnes Mahomva, country director for the Elizabeth Glaser Paediatric AIDS Foundation, told IPS that 90-90-90 is not too ambitious for the Southern African country.

Already, she told IPS, “HIV positive pregnant and breast feeding mothers are universally eligible for ART for life as well as HIV positive children below five years, regardless of their CD4 count.”

While many experts are optimistic that 90-90-90 targets will be met, Ugandan HIV activist Annabel Nkunda says the targets do not necessarily speak to each other.

Nkunda told IPS that many HIV positive people, “when put on treatment, do not adhere to the treatment because of stigma.”

Without a specific target to reduce stigma, she says, “no amount of intervention will get us to zero HIV/AIDS.”

But some experts like Dr Matu disagree: “If you know your status, you are more likely to be put on HIV care. If you are on ART, you are more likely to stay within the health system for follow up.”

Finding funding

While it is still too early to estimate how much countries will spend to make 90-90-90 work, the consensus is that a lot of resources will be needed. Already, some African countries are exploring innovative financing options such as AIDS tax levies and national HIV trust funds.

Gouws-Williams points out that ART has become far more affordable. In Malawi, it costs less than 100 dollars per person per year.

Nonetheless, donor assistance will still be critical, especially for five poor countries where HIV treatment costs exceed five percent of gross domestic product (GDP) – Malawi, Lesotho, Zimbabwe, Mozambique and Burundi.

Matu says that achieving 90-90-90 requires a combination of factors, including a robust health system, good laboratory capabilities, cheaper viral load testing and a strong health work force.

Mahomva adds that a strong community component is needed, “because this is where several bottlenecks such as stigma happen, compromising adherence to HIV treatment.”

In spite of the uphill task ahead, many are optimistic that 90-90-90 will write the final chapter of the AIDS epidemic.

Edited by: Mercedes Sayagues

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OPINION: The Fight Against the Long-Term Effects of Child Hunger Reaches Fever Pitchhttp://www.ipsnews.net/2014/09/opinion-the-fight-against-the-long-term-effects-of-child-hunger-reaches-fever-pitch/?utm_source=rss&utm_medium=rss&utm_campaign=opinion-the-fight-against-the-long-term-effects-of-child-hunger-reaches-fever-pitch http://www.ipsnews.net/2014/09/opinion-the-fight-against-the-long-term-effects-of-child-hunger-reaches-fever-pitch/#respond Wed, 24 Sep 2014 08:18:42 +0000 Dr Noel Marie Zagre and Ambassador Gary Quince http://www.ipsnews.net/?p=136847 Dr. Noel Marie Zagre, MPH, PhD is UNICEF’s Regional Nutrition Adviser for Eastern & Southern Africa and Ambassador Gary Quince is Head of the European Union Delegation to the African Union.

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A nutritionist assesses the health of a child in the Sahel. Red indicates severe malnutrition. Credit: Kristin Palitza/IPS

By Noel Marie Zagre and Gary Quince
JOHANNESBURG, Sep 24 2014 (IPS)

Eric Turyasingura chases after a ball made from plastic bags outside his mud-brick home in the mountains of southern Uganda.

Yelling in his tribal tongue, Nkore, “Arsenal with the ball! Arsenal with the ball!” he jostles with his younger brothers for possession. 

The fame of the English soccer club has reached even his little ears. Pretending to be a sports star offers a moment of escape from his daily struggles.

At five years old, Eric’s tiny body already tells a story of poverty and lost opportunity. He is six inches shorter than he should be for his age. His arms and legs are pencil-thin and his head is out of proportion to his body.

Because he is stunted, experts say his chances growing up healthy, learning at full potential, and getting a job, let alone play professional soccer, have been greatly diminished.

In 2013, a United Nations Report said one in four children under five years, across the world – a total of 165 million – were stunted, while last year The Lancet estimated that undernutrition contributed 45 percent of all under-5 deaths.

Often beginning in the womb as poverty-stricken mothers live hand-to-mouth, stunting can be a lifelong affliction. Studies show it is linked to poor cognition and educational performance, low adult wages and lost productivity. A stunted child is nearly five times more likely to die from diarrhoea than a non-stunted child because of the physiological changes in a stunted body.

Development agencies say significant progress has been made in ensuring children are properly nourished, and as a result, the incidence of stunting is declining.

However, huge challenges remain and in sub-Saharan Africa, the proportion of stunted under-fives is two in five. With crises in South Sudan, the Central African Republic, Syria and now Iraq displacing millions of people, combating hunger and ensuring stunting rates don’t creep back up has become a top priority.

“We will not eliminate extreme poverty or achieve sustainable development without adequate food and nutrition for all,” said U.N. Secretary General Ban Ki Moon at a meeting of global hunger agencies in Rome.

“We cannot know peace or security if one in eight people are hungry.”

As such, the first “pillar” of Secretary General’s “Zero Hunger Challenge” aims to eliminate stunting in children under two years old.

The United Nations Children’s Fund (UNICEF) is also a partner in the Scaling Up Nutrition (SUN) Movement, another major global push, bringing together more than 50 countries in an effort put national policies in place and implement programme with shared nutrition goals.

One innovative programme – the Africa Nutrition Security Partnership, being implemented by UNICEF and funded by the European Union since 2011- is combating stunting both at the community level and the institution level.

Acutely malnourished children at risk of death are directed to health clinics, and at the same time health institutions and partners are given the tools they need to improve infant and young child feeding practices and hygiene, and better fight hunger and disease. The four-year programme focuses on Ethiopia (with a stunting rate of 44 percent), Uganda (33 percent), Mali (38 percent) and Burkina Faso (35 percent).

The aim is to change behaviour among households, set up systems for effective multisectoral approaches and increase government capacity, enabling these countries to battle against the effects of hunger long after the programme is complete.

In Uganda, for example, community workers have been provided with smart phones, programmed with information about hygiene, postnatal care and proper infant and maternal diet. The workers share the information with household members and then log their location on the smart phone’s GPS to prove they were there.

In Mali’s capital, Bamako, funding has been provided to broaden a master’s degree to provide advanced training to healthcare professionals about how to best design and implements nutrition programmes.

In Ethiopia, schoolgirls are being encouraged to delay marriage and pregnancy until they are at least 18, as a way of preventing intergenerational undernutrition. Older women are better able to carry a baby and rear children with stronger bodies and minds.

The increased focus on stunting by the humanitarian community is telling: its prevalence has become a kind of litmus test for the well being of children in general. A child who has grown to a normal height is more likely to live in a household where they wash their hands and have a toilet; is more likely to eat fruit and vegetables, is more likely to be going to school; is more likely to get a good job; and is less likely to die from disease.

Moreover, tipping the balance in favour of a child’s future isn’t as hard as some might think. The simple act of reinforcing the importance of exclusively breastfeeding a baby for the first six months of his or her life, for example, increases an infant’s chances of survival by six times.

Most of the regions where the partnership is being run have ample food to go around. It is other factors, such as failing to properly wash and dry utensils after meals, selling nutritious homegrown foods at market rather than eating them, and cultural sensitivities to things like vegetables and eggs that are causing problems. As such, simply education programmes can make a real difference and save countless lives.

The other challenge is ensuring there is enough political will to keep those programmes running. If the international community remains focused, the downward trend in stunting will continue. It could only be a few short years before children from modest African communities like the mountains of southern Uganda get to really play for teams like Arsenal. Children just need to be allowed to grow to their full potential and good things will follow.

Edited by: Nalisha Adams

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