Inter Press Service » Countdown to ZERO News and Views from the Global South Mon, 29 May 2017 18:27:20 +0000 en-US hourly 1 Zimbabwe Faces Troubling Spike in Cases of Multi-Drug Resistant TB Sun, 25 Jan 2015 23:29:26 +0000 Jeffrey Moyo 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

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/AIDS Sat, 17 Jan 2015 21:39:58 +0000 Jeffrey Moyo Many children under 15 in Zimbabwe discover their HIV status only when they fall critically ill later in life. Credit: Jeffrey Moyo/ IPS

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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For Zimbabweans, Universal Education May be an Unattainable Goal Wed, 24 Dec 2014 16:39:07 +0000 Jeffrey Moyo 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

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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AIDS Response Is Leaving African Men Behind Fri, 12 Dec 2014 22:13:34 +0000 Miriam Gathigah 3 What Future for the ACP-EU Partnership Post-2015? Fri, 12 Dec 2014 20:04:37 +0000 Valentina Gasbarri 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

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 Dwellers Tue, 09 Dec 2014 18:51:05 +0000 Jeffrey Moyo 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

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 Asia Tue, 09 Dec 2014 13:22:20 +0000 Pavol Stracansky 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

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 Leone Mon, 01 Dec 2014 23:55:06 +0000 Lansana Fofana 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

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 Women Mon, 01 Dec 2014 13:07:39 +0000 Nqabomzi Bikitsha Gender inequalities drive the disproportionate rate of HIV infection among young South African women aged 15 to 24. Credit: Mercedes Sayagues/IPS

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

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.”


• 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 Teenagers Fri, 21 Nov 2014 12:02:19 +0000 Sam Olukoya 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.

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.


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.



• 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 AIDS Fri, 14 Nov 2014 07:01:03 +0000 Charlton Doki 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

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 Africa Fri, 07 Nov 2014 07:24:48 +0000 Miriam Gathigah 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

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 HIV Fri, 31 Oct 2014 05:27:07 +0000 Mercedes Sayagues 0 Writing the Final Chapter on AIDS Fri, 17 Oct 2014 06:50:55 +0000 Miriam Gathigah Testing, treating and suppressing viral load in massive numbers could curb the spread of AIDS by 2020. Credit: Mercedes Sayagues/IPS

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 Pitch Wed, 24 Sep 2014 08:18:42 +0000 Dr Noel Marie Zagre and Ambassador Gary Quince A nutritionist assesses the health of a child in the Sahel. Red indicates severe malnutrition. Credit: Kristin Palitza/IPS

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

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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Saving the Lives of Cameroonian Mothers and their Babies with an SMS Tue, 23 Sep 2014 08:23:01 +0000 Ngala Killian Chimtom According to an African proverb, “every woman who gives birth has one foot on her grave.” Cameroonians are attempting to make this proverb a historical fact and not a present reality through SMS technology. Credit: Mercedes Sayagues/IPS

According to an African proverb, “every woman who gives birth has one foot on her grave.” Cameroonians are attempting to make this proverb a historical fact and not a present reality through SMS technology. Credit: Mercedes Sayagues/IPS

By Ngala Killian Chimtom
YAOUNDE, Sep 23 2014 (IPS)

“You can’t measure the joy in my heart,” Marceline Duba, from Lagdo in Cameroon’s Far North Region, tells IPS as she holds her grandson in her arms.  

“I am pretty sure we could have lost this child, and perhaps my daughter, if this medical doctor hadn’t shown up,” Duba says, a smile sweeping her face.

The medic in question is Dr Patrick Okwen. He is the coordinator of M-Health, a project sponsored by the United Nations Population Fund (UNFPA) that uses mobile technology to increase access to healthcare services to communities “when they most need it.”

The World Health Organisation (WHO) recommends that a nurse or doctor should see a maximum of 10 patients a day. But according to Tetanye Ekoe, the vice president of the National Order of Medical Doctors in Cameroon, “the doctor-to-patient ratio in Cameroon stands at one doctor per 40,000 inhabitants, and in remote areas such as the Far North and Eastern Regions, the ratio is closer to one doctor per 50,000 inhabitants.”

Okwen was in Lagdo testing out the SMS system, which was just implemented a few months back, when Duba’s daughter, Sally Aishatou, went into labour.

Okwen and the medical staff at the Lagdo District Hospital received an SMS from Aishatou. She had been in labour for 48 hours with no signs that the baby was about to come.

“What happens when a woman SMSes a particular number, the GPS location blinks on the server, and then the server tries to identify her location, puts it on Google maps; then tells the driver to go there. [The system] also tells the doctor to come to the hospital; tells the nurses to get ready. So everybody gets into motion,” he tells IPS.

Okwen and the ambulance driver traced Aishatou to her home. They found her lying helpless on a mat, almost passed out. By the time the ambulance returned to the hospital, the operation room was ready for her and she was taken into surgery immediately.

Eight minutes later, her 4.71 kg baby boy was born. The midwife Manou nee Djakaou tells IPS: “The joy in me is so great that I don’t even know how to express it. I am so exited; very happy. This system put in place is very efficient. But for this innovation, we stood to lose this baby and its mother.”

Two hours after surgery, Aishatou regained consciousness and named her boy after Okwen.

According to the U.N. Children’s Fund (UNICEF), out of every 100,000 live births 670 women in Cameroon die. UNICEF figures also state that for every 1,000 live births, 61 infants died in Cameroon in 2012.

“Many women are dying from child-birth related issues. Women are dying while giving life. And this is something we are really concerned about, but we also know that with the coming of mobile technology, there is hope for women in Africa,” Okwen says.

“Most of the women in Africa today have access to a telephone. It could be her own, her husband’s own, or a neighbour’s. So if we had a way in which women could reach an ambulance using a phone that would guide the ambulance, it could indeed present hope for African women,” he explains.

Okwen says the project has benefitted “close to one hundred women in terms of information, evacuation, arrangements of hospital visits, deliveries and caesarean sections.”

The project has been dubbed “Tsamounde”, which means hope in the local Fufuldé language.

Mama Abakai, the Mayor of Lagdo, says the project’s impact has been far reaching.

“A lot of our sisters, wives and mothers in rural areas lose their lives and suffer a lot, because there is a communication gap, and a problem of rapid intervention and assistance. With this system, it suffices to send an SMS or a simple beep, and all the actors involved in saving lives are mobilised…its formidable,” Abakai tells IPS.

Dr. Martina Baye of Cameroon’s Ministry of Public Health calls the project a “revolution in Cameroon’s health care delivery system.”

She says that as a majority of women in the country’s far North Region have little access to healthcare services, the M-Health Project comes as a huge relief.

According to the 2010 Population census, the Far North Region has a population of three million people, 52 percent of whom are women.

“We look forward to using this technology in other parts of the country,” she tells IPS.

Edited by: Nalisha Adams

The writer can be contacted at:

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OPINION: Investing in Adolescent Girls for Africa’s Development Mon, 15 Sep 2014 07:50:24 +0000 Hinda Deby and Dr. Julitta Onabanjo Elina Makore, 19, of Renco Mine just after delivering a healthy baby at Rutandare Clinic a remote Zimbabwean outpost supported by the United Nations Population Fund (UNFPA). Courtesy: UNFPA/Stewart Muchapera

Elina Makore, 19, of Renco Mine just after delivering a healthy baby at Rutandare Clinic a remote Zimbabwean outpost supported by the United Nations Population Fund (UNFPA). Courtesy: UNFPA/Stewart Muchapera

By Hinda Deby Itno and Julitta Onabanjo

Adolescence is a time of transition from childhood to adulthood. It is also a time of change and challenge. 

Today’s adolescents, connected to each other like never before, can be a significant source of social progress and cultural change.

But they are also facing multiple challenges that seriously impact their future. And nowhere in the world do adolescents confront as formidable barriers to their full development as in Africa.

Today, adolescents and young people make up over one third of Africa’s population. They form a sizeable part of the population yet they lack critical investments, especially where it matters most – in sexual and reproductive health services, comprehensive sexuality education and skills building.

This calls for the serious and committed attention of all.

  Challenges facing adolescent girls

It is estimated that Africa has the world’s highest rates of adolescent pregnancy and maternal mortality. In Chad, Guinea, Mali, and Niger, where child marriage is common, half of all teenage girls give birth before the age of 18.

This was the case for Zuera, a girl from Kano in northern Nigeria, who became a wife and a mother at just 14 years. She suffered the agony of two stillbirths and was treated for obstetric fistula, which is damage caused by childbirth that leaves a woman incontinent, that arose from her first pregnancy.

Zeura was robbed of her childhood. She also missed out on the transition phase of adolescence and finally, she missed life.

All over Africa, stories like Zeura’s are commonplace. Millions of girls become brides before the age of 15. Close to 30 percent of girls on the continent give birth by age 18, when they are still adolescents. These adolescents face a higher risk of complications and death due to pregnancy than older women.

Nearly two thirds of them lack the basic knowledge they need to access crucial sexuality education and health information to protect themselves from early pregnancy and sexually transmitted diseases.

Research has found that at least 60 percent of young people aged 10 to 24 years are unable to prevent HIV, due to a lack of sexuality education. We cannot allow this to continue.

A resilient and informed generation

Young people will carry the African continent into the future. They need a safe and successful passage to adulthood.

And this is not a privilege but a right. Yet this right can only be fulfilled if families, society, and government institutions make focused investments and provide opportunities to ensure that adolescents and youth progressively develop the knowledge, skills and resilience they need for a healthy, productive and fulfilling life.

Comprehensive sexuality education, sexual and reproductive health services, education and skills building for adolescents and young people need to be placed at the heart of the Sustainable Development Goals (SDGs), with specific indicators and targets.

By building a strong foundation and investing in programmes that focus on delivering and achieving specific results for adolescents, Africa can achieve its transformation agenda.

Our desire is for every young person in Africa to be resilient and informed. We want every young African to be able to make their own decisions, to foster healthy relationships, access proper health care, actively participate in their education and ultimately, contribute to the development of their community and their future.

This means that programmes that are achieving results for adolescents in various parts of Africa must be scaled up. These include the husbands’ schools that have been developed in Niger, the girls’ empowerment initiative in Ethiopia, and the child marriage-free zones in Tanzania.

International institutions need to increase their commitments to adolescents, and address the nagging problems that confront adolescent girls and women across the African continent.

Adolescents have the potential to shape their world and indeed, the world in its entirety. It is in our interest to connect with them and enable them to change our world. Yes indeed!

Edited by: Nalisha Adams


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How Niger’s Traditional Leaders are Promoting Maternal Health Thu, 11 Sep 2014 08:47:05 +0000 Joan Erakit Chief Yahya Louche of Bande, a village in Niger, addresses his constituents about maternal health and the importance of involving men. Credit: Joan Erakit/IPS

Chief Yahya Louche of Bande, a village in Niger, addresses his constituents about maternal health and the importance of involving men. Credit: Joan Erakit/IPS

By Joan Erakit
BANDE, Niger, Sep 11 2014 (IPS)

It is a long, 14-hour drive from Niger’s capital city Niamey to the village of Bande. And the ride is a dreary one as the roadside is bare. The occasional, lone goat herder is spotted every few kilometres and the sightings become a cause of both confusion and excitement since there aren’t any trees, or watering holes in sight.

Dry, hot and often plagued with sandstorms, Niger has a population of over 17.2 million, 80 percent of which live in rural areas. Insecurity, drought and trans-border issues contribute to this West African nation’s fragility where 50 percent of its citizens have access to health services.

IPS has travelled here with the United Nations Population Fund (UNFPA) to visit a school that — on a continent where male involvement in maternal health is not the norm and, in fact, men are oftentimes not present during the duration of the pregnancy or the birthing process due to cultural reasons — is pretty unique. It’s the School of Husbands.

Formed with support from UNFPA in 2011, the school has over 137 locations in Niger’s southern region of Zinder. Members are married men between the ages of 25 and 50, but young boys are now being recruited to come and sit in on meetings — to learn from their elders.

As IPS arrives at the village early one morning, a group of musicians approach the vehicle playing ceremonial music; they precede a traditional chief who is being escorted by his most trusted counsel and a throng of personal security who frantically chase away curious children with sticks.

Yahya Louche is the chief of Bande and he stops to talk to IPS about maternal health and the importance of involving men.

“I am a member of the School of Husbands,” Louche says of the informal institution that brings together married men to discuss the gains of reproductive health, family planning and empowerment.

“The School of Husbands is where there is no teacher and there is not student,” Louche continues, adding, “They are not getting paid, they are working for the well being of the population.”

The School of Husbands is a prime example of what can happen when men stand shoulder to shoulder with women, promoting safe births.

The Perils of No Care 

While visiting the health centre near the chief’s homestead, IPS spots a young woman making her way across the compound to the maternity room. She is weak and can barely make eye contact while two friends hold her up by each arm.

IPS is told that she delivered a baby at home and has walked kilometres to get help because she began bleeding profusely – it is an obstetrical emergency known as postpartum haemorrhage (PPH).

According to the World Health Organisation (WHO), PPH is responsible for about 25 percent of maternal mortality. Without prenatal or antenatal visits during pregnancy, complications are more likely to arise — some often leading to death.

“Before the School of Husbands, women didn’t want to go for delivery at health centres, they would stay at home and have their babies,” Louche explains.

According to the World Bank, Niger has a Maternal Mortality Ration (MMR) of 630 to 100,000 live births.

Women in Niger suffer.

It is a very well-known custom in the country that women are not to show their pain or discomfort. When they give birth, it is often in silence.  The woman on the delivery table makes no sound though pain is very visible on her face.

Madame Doudou Aissatoo, a midwife in Konni, a town in Niger, tells IPS that it is important to have reproductive health and family planning services readily available because many women walk for miles to come to the health centres. If commodities and services, or even midwives are unavailable, the women will leave and not return for a very long time.

“The very critical thing is to integrate it in the package; when a woman comes to the health centre for whatever reason, she has to get the family planning right away, whether it is a routine health check-up or something serious. Even on Saturday or Sunday, if a woman comes to the health centre, she’ll get it,” Aissatoo says.

Returning Home to Promote Health

The ancient story is quite fascinating; when a young boy leaves his homestead to find greener pastures, a time will mostly likely come when the folks back home call upon the man to become chief.

Often leaving the diaspora to fulfil his duties, a request to become chief is one that cannot be refused for turning it down is the equivalent to shaming ones ancestors.

It is such that the chiefs in Niger today come from different professional backgrounds and many have been doctors, diplomats and professors.

Traditional chiefs in Niger are the most important leaders — even heads of state and presidents seek their council before making big decisions. Without their blessing, one can assume that the road ahead will be difficult.

The UNFPA country office has understood the role that traditional chiefs play and has built a partnership in favour of promoting the health and rights of women.

In 2012, the traditional chiefs of Niger signed an agreement with UNFPA furthering a commitment to improve the health conditions of women.

“When we gathered in 2012, we made a commitment as an organisation to work with UNFPA in order to reduce the demographic growth, be part of sensitisation activities and gear towards improving reproductive health,” Louche explains.

When asked if she feels good about her husband participating in the institution, Fassouma Manzo, a local woman replies ecstatically: “Very much!”

A round of applause follows Manzo’s declaration as she continues, “before the School of Husbands, men didn’t have discussions with their women; but now, there is an issue for which they are very interested. As a woman, you can now find a space where you can talk and share with your man.  It’s a great side effect!”

Louche, a charismatic chief who spends much time talking to his constituents truly believes that empowering men puts the focus put on women.

The School of Husbands doesn’t just highlight the importance of seeking professional medical care when pregnant, but it also works to promote understanding between men and women — a gain that will only foster harmony for both sexes.

Edited by: Nalisha Adams

The writer can be contacted through Twitter on: @Erakit

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How Midwives on Sierra Leone’s Almost Untouched Turtle Islands are Improving Women’s Health Tue, 26 Aug 2014 15:02:40 +0000 Joan Erakit The eight islands that comprise Turtle Islands, Sierra Leone, are remote and practically untouched by modern civilisation. Credit: Joan Erakit/IPS

The eight islands that comprise Turtle Islands, Sierra Leone, are remote and practically untouched by modern civilisation. Credit: Joan Erakit/IPS

By Joan Erakit
MATTRU JONG, Sierra Leone, Aug 26 2014 (IPS)

Emmanuel is a male midwife.

At the age of 26, he lives and works on one of eight islands off the southwest peninsular of Sierra Leone, an hour by speedboat from Mattru Jong, the capital of Bonthe District.

On a particularly hot Wednesday morning, IPS joins Marie Stopes, United Nations Population Fund (UNFPA) and Sierra Leone’s Ministry of Health to go and visit a population on one of the Turtle Islands that is practically untouched by modern civilisation.

Marie Stopes is a British-based non-profit that provides family planning and reproductive health services to over 30 countries around the world. They work as a back-up support system to the government, filling in the gaps in hard-to-reach areas that the government is still working to resource.

On the mainland of Mattru Jong there is a small market, situated on the river Jong which flows into the Atlantic ocean, and crowded with various kiosks boasting fish, vegetables and live chickens tied at their feet in straw baskets.

To reach the islands, one has to travel by boat. But all the islands don’t have landing docks and the boats sometimes stop in knee-deep water. Passengers — and midwives visiting the islands to provide reproductive health and family planning services — have to hoist their belongings and supplies above water, to make their way to the villages.

“Their [midwives] challenge is that they don’t have a boat. If you want to do this effectively, you need a good boat,” Safiatu Foday, a regional family planning coordinator for UNFPA in Sierra Leone, explained to IPS.

For island communities that have very little access to the mainland, basic health information is difficult to come by, therefore the risks — especially those pertaining to pregnancy, become inevitable.

With a population of over six million, where women of childbearing age are between the ages of 15 and 49, this West African country has refocused its health initiatives, working tirelessly to strengthen the capacity and training of skilled midwives — an exceptional tool in reducing maternal and infant mortality.

It Takes a Village

The village is inhabited by about a few hundred people — most of them large families, many of whom have just started utilising the peripheral health unit (PHU) that is onsite.

Emmanuel, one of the first men to undertake the position of midwife in this area, is the person “in-charge,” facilitating prenatal visits, deliveries, antenatal care, attending to illnesses and referring patients to a hospital when needed.  

“There are people who since their birth, have never left the island,” Fadoy said.

Some of the women say they have delivered 13 or 14 children prior to the work of Marie Stopes in their village.

Others recount having no time to “rest” or take care of their other children while being pregnant almost every year.

There are common reasons as to why women become pregnant so consistently.

One woman shares that there is a fear of being “abandoned” by one’s husband. The women say if they do not engage in sexual intercourse during the marriage, their husbands will look elsewhere. Therefore women feel they have no choice but to keep getting pregnant.

There is also the question of approval; many women must obtain permission from their husbands to start using contraceptives.

“We used to get pregnant all the time and our husbands would abandon us, so we had to fight for ourselves to survive. Since Marie Stopes came to the island and we now have access to contraceptives, we are able to take care of ourselves,” Yeanga, 33 tells IPS, adding, “It has created an impact in my life, one, because I now know about spacing births.”

Yeanga is the mother of five children with the oldest aged 25, and the youngest only three years old.

Before going on family planning, Yeanga admits to having difficulties with her husband, which were only heightened when he found out that contraceptives would help her not to get pregnant.

“Even when I wanted to join family planning, my husband was not agreeing, but I talked to him about it and we finally agreed to allow me to start family planning.”

In order to fully meet the demand of women who are in search of family planning and reproductive health services, the government has come up with an interesting strategy: recruit and train traditional birth attendants (TBA’s) to provide quality health care services in the villages.

Because they are from the village, they are both respected and valued, thus their insight, advice and knowledge are taken very seriously.

“Before midwives came to the island, there were just TBA’s doing deliveries in this area – and there were a lot of problems with these births,” Isatu Jalloh, 28, a nurse working in the village, told IPS.

Without skilled birth attendants, many of the women on the island suffered complications like preeclampsia, fistula and even death.

Though Sierra Leone has one of the highest maternal and infant mortality rates, 140 infant deaths per 1,000 live births, and 857 maternal deaths per 100,000 live births, Jalloh believes that the maternal death rate on the island has reduced due to the advocacy of midwives who travel to the island to promote family planning and reproductive health.

The ability to choose when to have children has allowed women on the island to pursue small economic ventures. They are able to produce an income to not only take care of themselves, but also their children.

The Future is Bright?

As the last few hundred days of the United Nations Millennium Development Goals (MDGs) come to a close, Sierra Leone stands at an interesting cross section: that of incremental success and challenges to come.

Demand for reproductive health and family planning services is high, the commodities are being supplied through partnerships with UNFPA and Marie Stopes, midwives are being dispatched to different districts, yet obstacles remain.

Most trained midwives deployed to health centres far from their homes don’t want to stay in those areas due to harsh working conditions and unfamiliarity with their surroundings.

And with the outbreak of Ebola, most midwives have been immediately evacuated, leaving patients, many of them pregnant women, without proper care.

Sierra Leone faces an opportunity to scale-up its reproductive health and family planning services by continuing its ability for form essential partnerships, most effectively illustrated in the one with civil society and advocacy group, Health Coalition for All.

“Our focus is on health and health-related issues. The key areas are advocacy and monitory, we work to ensure that services are available, accessible, affordable and that they reach the beneficiary,” Al Hassane B. Kamara, a programme manager for the coalition, shared with IPS.

Based in Makeni, in Northern Province, the Health Coalition for All has played an essential role in ensuring that women have access to healthcare, especially during pregnancy.

By addressing the issues such as lack of trained staff, delivery of commodities and most importantly, the high user fees during clinic visits, the coalition takes a proactive stand to ensure that women do not end up in unqualified hands.

“They pay very high fees to see a qualified doctor, especially for cesarean operations.  As a result they have no options but to work with the TBA or a “quack doctor.”

With programmes such as the Free Health Care Initiative (FHCI) that allows pregnant mothers, lactating mothers and children under the age of five to access services for free, Sierra Leone continues to put its focus on reproductive health.

 Edited by: Nalisha Adams

The writer can be contacted through Twitter on: @Erakit

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No Hope for AIDS-Free Generation in Uganda as Controversial HIV Bill is Signed into Law Thu, 21 Aug 2014 01:43:19 +0000 Amy Fallon Uganda has been hailed as a success story in fighting HIV/AIDS, with prevalence rates dropping from 18 percent in 1992 to 6.4 percent in 2005. But activists fear a new HIV Bill will lead to lead to people shunning testing and treatment. Credit: Amy Fallon/IPS

Uganda has been hailed as a success story in fighting HIV/AIDS, with prevalence rates dropping from 18 percent in 1992 to 6.4 percent in 2005. But activists fear a new HIV Bill will lead to lead to people shunning testing and treatment. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 21 2014 (IPS)

HIV/AIDS activists are adamant Uganda will not achieve an “AIDS-free generation” now a “backwards” HIV/AIDS Bill criminalising the “wilful and intentional” transmission of the disease has been signed into law.

The act, they say, will lead to people shunning testing and treatment, but will particularly drive sex workers and gay men underground, and make women more vulnerable to domestic violence.

News that the controversial law, adopted unanimously by Parliament on May 13, and assented to by Uganda’s President Yoweri Museveni on Jul 31, broke on social media only this week on Aug. 19.

The bill also allows medical providers to disclose a patient’s HIV status to others without consent and prescribes mandatory testing for pregnant women, their partners, and victims of sexual offences.

Uganda has been hailed as a success story in fighting HIV/AIDS, with prevalence rates dropping from 18 percent in 1992 to 6.4 percent in 2005.

But Museveni went against earlier promises to the Joint United Nations Programme on HIV/AIDS (UNAIDS) executive director and campaigners that he wouldn’t back the punitive law.

“This is a populist act,” Kikonyongo Kivumbi of the Uganda Health and Science Press Association (UHSPA-Uganda) told IPS.

“He knows what he’s doing is not the right thing in addressing the general public health concerns in this country.”

Kivumbi pointed out that according to the 2014 UNAIDS Global Progress report, Uganda was now the third country in the world contributing to sustaining the pandemic.

Other campaigners are “heartbroken” and “outraged” after the president approved the HIV Prevention and Control Bill.

The news broke as CSOs were still waiting for an audience with Museveni over the controversial bill, which has been slammed by Uganda’s own AIDS Commission and the AIDS Control programme of the Ministry of Health (MoH).

“Some bad news from Uganda. Please pray for us,” Jacquelyne Alesi, director or programmes at Uganda Network of Young People Living with HIV & AIDS (UNYPA), said in an email to IPS.

The legislation prescribes a maximum 10 years in jail, a fine of about five million Ugandan shillings (1,980 dollars) or both for anyone who “willfully and intentionally transmitting HIV/AIDS to another person”.

Another provision of the law, drafted in 2008, provides for a fine or a maximum five years in jail for those convicted of “attempted transmission”.

According to the 2011 Uganda AIDS Indicator Survey, overall HIV prevalence is higher among women (8.3 percent) than among men (6.1 percent).

“Usually HIV bears the face of a woman,” Dorcas Amoding, policy, advocacy and networking officer for Action Group for Health Human Rights and HIV/AIDS (AGHA-U), told IPS.

“So if she has tested positive and perhaps the husband becomes aware of it…he might treat this as a very negative result as well and she can be attacked.”

Amoding added, “it even brings about a very huge burden in terms of women inheriting property, because some people still think HIV is a death sentence.”

“So if I say ‘I want to have my husband’s property for the children’, people are going to say ‘you’ll die tomorrow, you’re HIV positive.’”

Most LGBT people with HIV/AIDS already “die silently” and many were no longer going for services in the after the passing of the Anti-Homosexual Act, Bernard Ssembatya, from Vinacef Uganda, a sexual health and reproductive NGO focusing on HIV, told IPS. The anti-gay law was, however, declared “null and void” by the constitutional court on a legality earlier this month.

“Some of them are wary of going to health services, some health providers are also scared of delivering services,” Ssembatya said.

There will be “an increase in deaths from HIV, more infections” as a result of the HIV/AIDS law, he warned.

According to AIDS Free World, over 60 countries criminalise the transmission of HIV or the failure to disclose one’s HIV status to sex partners, or both. Global Commission on HIV and the Law members have highlighted Guinea, Senegal and Togo, which they say in recent years have revised existing, or adopted new laws which limit HIV transmission to exceptional cases of wilful transmission.

Guyana also rejected a criminalisation law. In the U.S, 34 states still have HIV specific criminal statutes, however, in May Iowa approved a law revising a HIV specific statute.

Kivumbi pointed out that criminalisation was an “agenda of the U.S. republican right”, who he accused of influencing political and public health appointments in Uganda.

“We need to tell U.S. republican extremists and evangelical Christians to leave managing the HIV pandemic to ourselves,” he said.

“Just because the U.S. gives us money it does not mean [they] can impose their extremist agenda on us.”

Uganda had deliberately chosen to “moralise the pandemic and response, emphasising abstinence at the expense of condom use and other scientifically proven interventions,” Kivumbi said.

“We have had cabinet ministers, parliamentarians and other people at senior government level saying that people who are HIV positive are morally bankrupt,” the activist said.

Kivumbi said there was an “element of politicking” on Museveni’s part in inking his signature on the bill. Uganda will be submitting a “concept note” to the Global Fund to Fight AIDS, Tuberculosis and Malaria on Oct. 15, and wanted to get access to a 90-million-dollar loan from the World Bank that was suspended, he said.

One clause of the HIV/AIDS Bill seeks to set up an AIDS Trust Fund managed by the MoH, with money coming from foreign governments and international agencies, among other means.

Ironically, that loan was put on hold in February, just days after the president approved the Anti-Homosexuality Act.

“I think that the president thought that by signing this law, which [sets up] the AIDS Trust Fund, the World Bank would give him money and the Global Fund would contribute,” said Kivumbi.

“Let the Global Fund and the World Bank not be fooled.

”This law tramples upon basic civil liberties and cannot be acceptable in a free and democratic society that Uganda aspires to be.”

Dianah Nanjeho, a communications consultant at Uganda Network on Law, Ethics and HIV/AIDS (UGANET), which works with a coalition of 40 organisations, told IPS the activists wanted the contentious clauses in the bill to be amended.

“The act in itself is a good act we don’t condemn it, we just want those one, two three things sorted out.”

She said the positive parts of the law were state obligations to provide care and treatment and the establishment of the AIDS Trust Fund.

Nanjeho said CSOs, who are still hoping to meet Museveni, hadn’t ruled out challenging the law in court, and would make a decision on this in the next few days.

“For now we are all weighing all options,” she said.

Edited by: Nalisha Adams

The writer can be contacted on Twitter @amyfallon 

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