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

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

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

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

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

But testing babies is not easy in poor countries.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New solutions to old problems

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

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

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

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

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

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

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

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

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

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

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

By Davison Mudzingwa
JOHANNESBURG, Dec 23 2014 (IPS)

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

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

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

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

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

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

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

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

SILENT SUFFERING: MEN, MANHOOD AND HIV

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

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

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

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

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

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

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

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

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

Rwandan children orphaned by AIDS in Muhanga village. Credit: Aimable Twahirwa/IPS

By Julia Hotz
WASHINGTON, Aug 9 2014 (IPS)

Though West Africa’s massive Ebola outbreak may be dominating the spotlight within the global health community, HIV/AIDS remains an enormous issue for Africa as a whole – a sentiment that Washington officials made clear this week in their discussions of legislative and technological setbacks plaguing progress in fighting the epidemic.

Despite the World Health Organisation’s announcement Friday that Ebola is now an “international public health emergency,” doctors, academics and policymakers met Thursday at the Washington office of Kaiser Family Foundation (KFF), a health-policy non-profit, to discuss the similarly urgent threat posed by HIV/AIDS, the subject of last month’s 2014 International AIDS Conference in Melbourne, Australia.Uganda’s anti-LGBT environment may explain the nation’s distinct increase in the number of new HIV infections, a trend that - with the exception of Angola - has been reversed in surrounding African nations.

Ambassador Deborah Birx, the global AIDS coordinator for the U.S President’s Emergency Plan for AIDS Relief (PEPFAR), echoed the threat’s urgency, explaining that “the AIDS pandemic in southern Africa is the primary cause of death for adolescents, and the primary killer of young women.”

President Barack Obama announced Wednesday at the end of his three-day leaders’ summit with Africa that PEPFAR and the Children’s Investment Fund Foundation (CIFF) will pledge 200 million dollars to work with 10 African countries to help them double the number of children on lifesaving anti-retroviral drugs.

But Ambassador Birx, along with other prominent HIV/AIDS activists in Washington, seemed to suggest that distributing anti-retroviral drugs to children would only address a fraction of the issue.

Fear of HIV/AIDS stigma

While making note of PEPFAR’s unprecedented  progress in moving towards an “AIDS-free generation,” a commitment that President Obama deemed possible in a 2013 national address, Birx suggested that countries with anti-LGBT laws may have disproportionately high rates of new HIV infections.

“People are afraid to be stigmatised,” Birx told IPS, explaining that gay people may refuse to seek diagnosis and treatment for HIV/AIDS if they are legally and culturally persecuted by their homeland.

Identifying nearly 80 countries with such discriminatory environments, Birx’s PEPFAR report highlights Uganda, where the recent passage of anti-LGBT legislation and discriminatory comments of Ugandan President Museveni has attracted substantial condemnation from the international community.

“This is a human rights question,” Birx told IPS, calling specifically on the community of faith- one she describes as “there to wrap its embracing arms in need”- to respond to such LGBT persecution.

Yet beyond humanitarian concerns, PEPFAR’s report notes how Uganda’s anti-LGBT environment may explain the nation’s distinct increase in the number of new HIV infections, a trend that – with the exception of Angola – has been reversed in surrounding African nations.

Birx stressed that the majority of HIV infections are transmitted through heterosexual sex, despite the common misperception that homosexual activity is the cause of HIV/AIDS.

It is perhaps this association, Birx reasoned, that incites fear of seeking diagnosis, and explains why approximately half of all people with HIV are still unaware that they are infected, despite the tremendous increase in HIV testing capacity.

“Incredibly powerful” potential of tech innovation

Panelists at Thursday’s conference spoke about the tremendous expansion of testing capacity, an noted how technological innovation is a leading force not only in HIV/AIDS diagnosis, but also in treatment, prevention and education.

“I think there’s actually a lot going on in innovations in technology,” Chris Beyrer, president of the International AIDS Society, told IPS. “And it’s not only internet technology and mobile technology, but it’s also in other domains, like self-testing and home-testing.”

Beyrer added how “getting testing out of the clinics and getting them directly to people” reduces the strain on medical personnel and funding, two areas in which panellists agree there are great shortages.

“Technology is moving to a place where there are much more local kinds of facilities that can actually do staging,” Beyrer explained to IPS.

“You don’t have these kinds of problems with people waiting forever to get a CD4, and then being told to go somewhere else with their CD4 result.”

“One size does not fit all”

Birx, who also participated in Thursday’s panel, added that technology can potentially be used to disseminate information about HIV/AIDS, and can potentially even correct some of the misconceptions about what causes HIV/AIDS.

She referenced the “incredible work” coming out of Cambodia, which utilises different internet strategies to cater not only to people of different ages, but also to people of different sexual practices, in an attempt to distribute key medical information.

The technique, she says, allows everybody to “click on the site and find the voice that resonates with them and gives them different knowledge [about HIV/AIDS] that they need.”

“I found that so incredibly powerful, and if we can figure out how to do that and get broadband throughout sub-Saharan Africa, it would be terrific.”

Beyrer reiterated the need for technology to offer individualised options for the transmission of knowledge about HIV/AIDS, telling IPS that “one size doesn’t fit all in these innovations.”

“It turns out, for example, from looking at interactive supports for treatment, there are very age-dependent differences even among population,” he said.

“Men under 25,” Beyrer explained, “really like SMS interactive messages, and want to be notified at all times, while older men [tend to say] no thank you, leave me alone…it’s very specific so we’re going to have to get that right.”

Yet despite Beyrer’s enthusiasm for more individually-tailored solutions to those seeking knowledge about HIV/AIDS, he also urges that there be more awareness-building for those not expressly seeking knowledge about HIV/AIDS.

“One sector that hasn’t engaged very much in HIV is social media,” he said, calling specifically on Facebook, Google, and others in Silicon Valley to engage more thoroughly.

“We need that, and we would love them to be way more engaged than they are.”

Edited by: Kitty Stapp

The writer can be contacted at hotzj@union.edu

Many HIV positive teenagers struggle to disclose their status to their sexual partners. Credit: Mercedes Sayagues/IPS

By Wambi Michael
KAMPALA, Apr 8 2014 (IPS)

Silence is golden, it is said. But not for Constance Nansamba* from Uganda, who paid a dear price for keeping silent about being HIV positive and pregnant at age 18.  

“I was terrified. I ran away from my brother’s home. I could not follow the PMTCT [prevention of mother-to-child transmission] guidelines, so the baby is HIV positive,” she told IPS.“There are few designated adolescent-friendly outpatient health care facilities, while in-patient paediatric wards care for children up to age 12." -- Dr. Sabrina Kitaka, an adolescent health specialist

Nansamba knew she was born with the virus but, afraid of rejection, she did not tell her boyfriend. “We used a condom, he always complained, we abandoned the condom, I got pregnant.” Although he did not contract HIV from her, they broke up.

Nansamba, now 20, has found the courage to tell her story to help others. She is a member of Uganda Young Positives (UYP), an organisation that offers HIV counselling, testing and treatment adherence advice.

She told IPS that many teenagers born with HIV do not know their status when they start having sex, or they know but don’t tell their sex partners.

A survey by Uganda’s Mildmay Health Centre involving 200 adolescents receiving antiretroviral treatment found that 75 percent were not willing to disclose their HIV status to their sexual partners and 30 percent did not want to have protected sex.

“They simply don’t have information to guide them in negotiating disclosure, dual protection and consistent condom use,” said Nansamba. “I faced the same challenge because I would not discuss issues about sex with my elder brother, who was like my father.”

Nansamba’s parents died when she was a baby and her brother raised her.

HIV among the young

Uganda is a young country; nearly 80 percent of its 34 million people are below the age of 30.

National seroprevalence is 7.2 percent and, worryingly, is slowly rising. Among youth aged 15-24, five percent of women and two percent of men are HIV-positive, according to the Uganda AIDS Indicator Survey 2011.

The United Nations Children’s Fund’s Stocktaking Report on Children and AIDS 2013 estimates that Uganda has some 110,000 adolescents aged 10-19 living with HIV, of whom 64,000 are girls and 48,000 boys.

Emmanuel Elwanu was 14 years old when he learned that he had been born HIV positive. Fearing discrimination, he struggled with telling his HIV negative friends. “I had to go through a lot of counselling before I could open up,” he told IPS.

Elwanu was lucky: his school had weekly counselling sessions around HIV and he joined the Reach Out Mbuya Parish HIV/AIDS initiative.

“Many of my HIV positive colleagues out there are going through really difficult times with relationships,” explained the 18-year-old Elwanu. “I think about sex, but it is not my biggest priority.”

Elwanu, whose parents died while he was a child, has decided to abstain from sex until completing his studies.

Polly Nuwagaba, a counsellor with the Naguru Teenage Information and Health Centre in Kampala, told IPS that most adolescents have a problem with disclosure.

“They look healthy, they attract HIV negative partners, and they have sexual desires,” she explained. “Some tell us that when they say they have HIV, those they tell don’t believe it, and they end up having unprotected sex.”

No condoms for teens

Dr. Sabrina Kitaka, an adolescent health specialist at Makerere University’s College of Health and Sciences in Kampala, notes the gap in health services for the youth.

“There are few designated adolescent-friendly outpatient health care facilities, while in-patient paediatric wards care for children up to age 12. So adolescents are typically admitted to adult wards,” said Kitaka.

In 2013, the World Health Organisation (WHO) warned that the failure to put in place effective HIV services for youth has resulted in a 50 percent increase in AIDS-related deaths among adolescents globally, compared with the 30 percent decline of such deaths in the general population from 2005 to 2012.

WHO asked governments to review their laws to make it easier for adolescents to obtain HIV testing without parental consent.

But Ugandan health officials are divided on whether teenagers should be offered family planning services and condoms.

Dr. Stephen Watiti, a physician who lives with HIV, observed that the laws and policies surrounding condoms and contraceptives for adolescents in Uganda are unclear and interpreted inconsistently. This makes it difficult for both youth and health staff to understand their options.

Officially, only those 18 and over qualify for family planning services and condom distribution. However, more than half of young women aged 18-24 had had sex before the age of 18, according to the 2011 Uganda Demographic and Health Survey.

“As clinicians, you cannot go to schools and promote condoms or contraceptives. But when you come across a 14-year-old who is sexually active, then you have no option but to teach them how to use condoms,” Watiti told IPS.

At the UYP meeting held in Kampala, the Ugandan capital, in late January, Nansamba told the young audience: “You guys, it is not easy to live with HIV. You will always feel guilty whenever you sleep with someone, but at the same time you have sexual desires that need to be fulfilled.”

Her decision these days is “to abstain [from sex] because I don’t want to put anybody at risk of HIV.”

But for many HIV positive teenagers, abstaining is not an easy option – and neither is disclosing their status or practicing safe sex.

*Name changed to protect identity.

Excerpt:

Zimbabwe has seen a significant increase in the number of teen mothers in recent years. Credit: Jeffrey Moyo/IPS

By Thandeka Moyo
BULAWAYO, Mar 14 2014 (IPS)

She is only 17, but each morning is a reminder of her losses in life. As Pretty Nyathi* forces herself out of bed, feeds her baby, bundles him on her back and rushes to the market to buy vegetables to sell on the streets of Bulawayo, Zimbabwe she wishes her life were different.

“There is nothing fancy about being a teen mother,” she told IPS. “I wish I could reverse the hands of time and go back to school and be like any other girl.”

Five years ago her mother died and Nyathi went to live with her grandmother, who runs a shebeen (informal bar) in Tsholotsho, 116 kms north-east of Bulawayo, Zimbabwe’s second-largest city.

At age 14, she was raped by a shebeen client. “I tried reaching out to my grandmother but she would threaten to throw me out,” she said.

Soon the grandmother forced the girl into prostitution with clients. “I have lost count of the men I slept with and I did not use protection,” said Nyathi.

In 2012 she ran away to Bulawayo, where she lived in the streets and survived through commercial sex. Two months later she found herself pregnant and was told at the clinic that she was HIV positive. A pastor took her to a shelter, and Nyathi started antiretroviral (ARV) treatment at Mpilo hospital.

“By the grace of the Lord, my baby is HIV negative,” said Nyathi.

She lives with a relative but struggles to follow the ARV treatment and have “a balanced diet that would help me live longer and at least see my daughter go to school.”

Nyathi is one example of the trend of rising teen pregnancies in Zimbabwe.

In 2011, the fertility rate among teenage girls aged 15-19 was 112 births per 1,000 girls, compared to 99 births per 1,000 girls in 2006, according to the Zimbabwe Demographic and Health Survey (ZDHS).

“That is a significant increase,” Stewart Muchapera, communications analyst with the United Nations Population Fund (UNFPA) in Zimbabwe, told IPS.

Girls living in the rural areas, like Nyathi, are twice as much affected by teenage pregnancies, at a rate of 144 births per 1,000 girls, compared to 70 births per 1,000 urban girls.

Risky pregnancies

“Puberty is a time of rapid biological change and this stage of development needs to be well managed for young people to pass through it safely,” said Muchapera.

Among the many causes of teenage pregnancy, he mentions the lack of adequate, accurate information on puberty, which leaves young people dependent on uninformed peer sources or unguided internet searches.

Some cultural or religious norms such as child marriage and social issues like intergenerational sex, sexual coercion and transactional sex also contribute to teenage pregnancy, he said.

The ZDHS reports that nine out of ten sexually active women aged 15 to 19 are in some form of a marriage, and that for two out of three girls who first had sex before age 15, sex was forced against their will.

In addition, the political and economic crisis of the last decade has brought widespread poverty and disruption of health and education services. Girls engage in risky transactional sex as a means to food, clothes, school and security.

Simanga Nkomo, a midwife in Bulawayo, told IPS that every year she assists younger mothers, some aged 14 and even younger.

“The increase is worrisome, as most of these teenagers are uninformed about maternal health and they risk succumbing to maternal mortality,” she said.

The risk of maternal death is twice as high for girls aged 15 to 19 than for women in their 20s, and five times higher for girls aged 10 to 14 years.

Sipho Ncube* is another teen mother from Bulawayo. She had good grades in her last year of high school but quit studying when she fell pregnant and gave birth to a baby boy, now seven months old.

“It started as a fling and one thing led to another until I discovered I was pregnant. I had knowledge of contraceptives but for some reason I did not use any,” she told IPS.

Ncube and her baby are HIV negative.  But it could easily have been otherwise: national seroprevalence is nearly 15 percent among adults aged 15-49.

Some 120,000 young Zimbabweans aged 15-19 contracted HIV in 2012, and 63.000 of these were girls, estimates the United Nations Children’s Fund.

Ncube’s parents, who work in South Africa, visit three times a year and send a little money. She looks after her siblings, aged 13 and seven, in a two-room rented house in Mpopoma, a high-density suburb. The baby’s father is working in Victoria Falls and helps financially whenever he can.

“I regret everything but I have to live with the silly choices I made,”  Ncube told IPS. “I wish to go back to school and be able to fend for the baby.”

* Names withheld to protect privacy

Model of Hope activist Sulemana Sulley lives positively with HIV and teaches others how to do it. Credit: Albert Oppong-Ansah/IPS

By Albert Oppong-Ansah
TAMALE, Feb 19 2014 (IPS)

With tears rolling down her cheeks, Zainab Salifu queued at the fevers unit of the Tamale Teaching Hospital in northern Ghana. Earlier in the day, the 18-year-old had been diagnosed HIV positive.

Despite the kind counselling offered by senior nurse Felicity Bampo, Salifu felt her world was crumbling. She wanted to die.

As Salifu told IPS, she began sobbing hysterically and dropped to the floor. People gawked at her. Then a middle-aged man approached her, took her hand and led her to a quiet corner.

“This is not the time for weeping,” he told Salifu. “Accept your condition. HIV is not a death warrant. Concentrate on taking your ARVs, eat well and exercise.”

“You are not alone, anyone can get the virus. Look at me,” he added.

Sulley works for Model of Hope, a volunteer group set up by Catholic Relief Services. Its 19 members in Tamale were trained as community counsellors by the Ghana AIDS Commission.

With a population of 540,000, bustling Tamale, 600 kms north of Accra, the capital, is the country’s fourth-largest city and hub of the northern region.

Every Tuesday and Friday, designated days at Tamale Hospital for HIV testing and ARV collection, volunteers are at hand to help people deal with a fresh diagnosis and check how patients on treatment are coping.

Bampo tests and counsels an average of six to 10 young people daily, most through doctors’ referrals. Few come by their own choice, she told IPS.

“Voluntary testing is not popular among young people because they fear being stigmatised”, she said.

Among sexually active youth aged 15-24, just four out of 10 women and only two out of 10 men have ever been tested, according to the 2011 Ghana Multiple Indicator Cluster Survey (MICS).

“Most people are aware of HIV and some of its symptoms but few know that ARVs will boost their immune system so they can live long,” said Bampo.

Low prevalence, high stigma

Ghana has a relatively low HIV prevalence of 1.4 percent, down from 2.3 percent in 2001.

Low prevalence brings its own problems: lack of familiarity with managing the disease, high levels of stigma and low levels of tolerance.

Just six percent of women and 15 percent of men aged 15 and above accept people living with HIV, according to the MICS.

Salifu, a final year trainee at a vocational school, told IPS that she was infected by her one and only boyfriend. She broke up with him but has not yet mustered the courage to tell him or her family about testing HIV positive in December 2013.

Like Salifu, seven out of 10 women would hide that a family member is infected with the AIDS virus.

Sulley blames the widespread perception that the virus brings immediate death and that one can contract HIV by associating with infected persons.

“We have stopped all our free testing events because the test kits have been directed to pregnant women.” -- Nuhu Musah, coordinator of the HIV and AIDS Support Unit
In 2013, Sulley counselled about 200 young people newly diagnosed, most of them students. Many had suicidal thoughts, and Sulley and his colleagues work hard to teach them to live positively and happily.

Sulley told IPS that several teenagers have committed suicide in recent years after learning they were HIV positive.

Nuhu Musah, coordinator of the HIV and AIDS Support Unit in Ghana’s northern region, regrets that the youth-oriented Know Your Status Campaign has been halted for lack of test kits.

“We have stopped all our free testing events because the test kits have been directed to pregnant women,” he told IPS.

The campaign held monthly outreach programmes in communities and at national events, like Independence Day, to encourage testing.

According to Musah, the northern region has four youth-friendly centres for HIV testing and sexual health but for lack of resources they are not working.

This will not improve the dismal figures of HIV testing and knowledge among young people.

Nationwide, only four out of 10 young men and women aged 15-24 have comprehensive knowledge about AIDS, the MICS found.

Northern Ghana has the lowest comprehensive knowledge for men and women, 17 percent, compared to 47 percent in Greater Accra.

MICS data show that Ghana is falling short of its target of having 95 percent of youth aged 15-24 fully informed about HIV by 2015.

“Comprehensive knowledge of HIV prevention and transmission is still low in Ghana, despite the many years of public sensitisation,” concluded the survey. “Concerted efforts should be directed at young people as many continue to get infected due to low levels of comprehensive HIV knowledge.”

A Nov. 15 town hall event on HIV/AIDS in New York. Credit: Courtesy of Matt Curtis/VOCAL-NY

By Samuel Oakford
NEW YORK, Dec 1 2013 (IPS)

Four hundred Eighth Avenue, home to the largest welfare centre for people with AIDS in New York, is the kind of grey, drab city building that seems like it was dragged, scowling, into the 21^st  Century.

Sandwiched between the banal hustle of Penn Station and the outer reaches of Manhattan’s once gritty waterfront, the corner of 30th street buttresses the north end of Chelsea, New York’s historically gay neighbourhood, where AIDS activism began over 30 years ago but today new glass condos price out long-time residents."If states like New York can take it that last lap, it can really provide this bellwether to say that it can be done.” -- Simon Bland

On a rainy afternoon in November, several HIV and AIDS Service Administration (HASA) clients stood out front, waiting for a drizzle to let up and chatting with workers, occasionally bumming cigarettes from them.

Inside, next to an older black gentleman blowing his nose and chatting on a cellphone about his boyfriend, a slight Latino man sat quietly watching a scratched-up television box and the neon ticker next to it that would show his number. The man was immediately recognisable to straphangers who ride the A, C, E and 2, 3 subway lines, where he has panhandled for years.

For more than a decade, activists have fought to include HIV-positive New Yorkers in protected groups that by law cannot be made to pay more than 30 percent of their assistance for housing. Currently, many are forced to choose between food and rent or have to enter the shelter system, which has swollen in recent years.

“City administrations have been relatively hostile to people with AIDS the last 20 years, since [Mayor Rudolph] Giuliani took office,” said Mark Harrington, a longtime activist and founder of Treatment Action Group (TAG).

But with new progressive mayor Bill de Blasio taking office in the New Year and a more attuned state government, activists are pushing to introduce a plan of action bolder than any before: to end AIDS in New York by 2020.

A long road home

In 1983, only two years into the pandemic in New York, playwright and AIDS activist Larry Kramer wrote “it is the sad and sorry fact that most gay men in our city now have close friends and lovers who have either been stricken with or died from this disease. Doctors are saying out loud and up front, ‘I don’t know.’”

Much has changed since then and the height of the epidemic a decade later, when nearly 10,000 New Yorkers were dying from AIDS every year.

Today, if the disease is caught early, HIV-positive young people following a strict anti-retroviral regimen can expect to have “near-normal” live expectancies. Needle exchange programmes have reduced infections among intravenous drug users in New York from over 13,000 a year to only 150.

Yet today the state is also home to more HIV-positive people than ever, an estimated 160,000 New Yorkers. Of those, 30,000 likely don’t know their status.

Gay men still make up the overwhelming majority of new cases, and among young gay men, infection rates are rising at an alarming 22 percent nationally.

Nationwide, African Americans silently make up 44 percent of new infections. In New York, people of colour make up 79 percent of the HIV-positive population.

Although a 2010 New York AIDS Institute study found that deaths among persons with AIDS had declined 82 percent since 1992, 2,000 New Yorkers still died of AIDS that year.

The same data showed that 46 percent of HIV-positive New Yorkers were not receiving regular care and 63 percent didn’t have their viral loads under control.

Disturbingly, a quarter of new HIV diagnoses are made when patients already have full blown AIDS.

So last year, frustrated by what they saw as a failed national AIDS strategy, Harrington and Charles King, CEO of Housing Works, sat down to come up with a plan for New York.

The national plan “was not a strategy to end the epidemic, it was a strategy to maintain an epidemic,” said King, who interrupted President Barack Obama at the White House unveiling to say as much.

“The technology is there, the tools are there,” King told IPS. “Do we have the political will to make it happen?”

Of course, without a cure, ending HIV is not on the horizon, but ending AIDS, the dangerous late stage of the virus, is something UNAIDS has already proposed globally with its “zero new infections, zero people dying of AIDS and zero stigma” campaign.

“Surveillance is the big picture,” Harrington told IPS. “On the community level we need to greatly increase testing among populations at risk, like young gay men and transsexuals.”

New York can learn from other cities, added Harrington. In San Francisco, the number of people who know their status increased “from about 80 percent to about 93 percent in the last six years – one of the ways they’ve done it is to increase testing among at risk communities from once a year to three or four times a year.”

If more people know their status, more are going to get proper treatment and get their viral loads under control.

Studies have shown that HIV-positive people on proper anti-retroviral treatment and with low viral loads can lower the chances of transmitting HIV to their partner by 96 percent.

“The first level of the end is control and very minimal transmission… reducing viral load as much as you can,” King told IPS. “If you got 80 percent of infected population virally suppressed, it would have a huge effect on transmission rates.”

“We should be encouraging everyone who is HIV-positive to start treatment,” he added.

The New York plan would institutionalise testing that can distinguish between chronic HIV patients those that have early, acute infections, when it is most contagious.

Exposed populations – intravenous drug users, gay men having unprotected sex or anyone who feels they don’t have control over how and with whom they have sex – would be further encouraged to use microbicides, vaginal rings and pre-exposure prophylaxis (PrEP) – the most common of which, Truvada, has been shown to reduce infection rates by up to 78 percent.

Post-exposure prophylaxis (PEP), a sort of morning-after pill for HIV which is effective up to 72 hours after infection, is already recommended to victims of sexual assault. But organisers want to increase awareness among doctors and hospital staff, who can be unfamiliar with when and how to use PEP.

Harrington says this year’s Affordable Care Act and will mean most New Yorkers will have healthcare and its prevention mandate will encourage more regular testing, prevention and treatment.

But organisers know they have their work cut out for them. For one, the image of AIDS as a survivable disease can be an obstacle.

“Younger gay men are not having as much sex with condoms as they did 20 years ago, when people were dying all around them,” said Harrington. “The reality is it’s far from over and there’s going to need to be a lot of resources and political action to end it.”

With the CDC predicting that half of young gay men will have HIV by the age of 50, ending AIDS is not a choice, he says.

“More than 30 million people have died and because of activism and research we have these amazing tools. We have a humanitarian imperative to do it but it also makes economic sense and as human beings if we have a chance to end the suffering, we have an obligation to do that.”

Other groups, including Vocal-NY, ACT-UP and GMHC have joined the coalition.

And after several activist think tanks and meetings with state officials, King is optimistic that Governor Andrew Cuomo will include a variation of their proposals in his 2014 State of the State in January. Doing so would send a message to other states.

If the crisis were to come full circle and end as a pandemic in the city where it first gained infamy, the implications globally would be huge, says Simon Bland, director of the New York Office of UNAIDS.

“How do we ensure that the complacency doesn’t set in? I think that if states like New York can take it that last lap, it can really provide this bellwether to say that it can be done.”

In Zimbabwe, four out of 10 sexually active girls aged 15-19 reported taking an HIV test in the last 12 months. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Nov 21 2013 (IPS)

Seventeen-year-old Natalie Mlambo* has two good reasons to get tested for HIV. She has two boyfriends and has unprotected sex with them. One is a high school classmate. The other is older, works in a bank, and can afford to give Mlambo small gifts and some money.

“Yes, I sleep with both,” Mlambo told IPS. And, since she has sex only with them, they have stopped using condoms, she explained.

But Mlambo is terrified of getting an HIV test. “I’m afraid,” she said. “It is better to stay in the dark than to know I’m facing death; treatment doesn’t eliminate the disease.”

Mlambo, a final year high school student from Harare’s Kuwadzana high density suburb, is not unique – neither in engaging in transactional sex and having multiple sexual partners, nor in fearing an HIV test.

Felicia Chingundu, an activist with Shingai-Batanai HIV/AIDS support group in Masvingo, a town 300 kms southeast from Harare, sees teen resistance daily.

“Teenagers engage in risky sexual behaviour but you hardly see them at testing centres,” Chingundu told IPS.

Zimbabwe set up early and robust prevention programmes in the 1990s that are credited with bringing the prevalence rate down from 24 percent in 2001 – one of the highest in the world – to less than 15 percent in 2012, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). Although a series of political and economic crisis after 2000 clipped many programmes, AIDS awareness is widespread.

One result is that more than half of young people aged 15-24 have comprehensive knowledge about AIDS, according to the 2011 Demographic Health Survey (DHS), a figure higher than the regional average. However, knowledge does not necessarily translate into action.

The Ministry of Health has set up mobile testing facilities that visit schools and testing centres in clinics. But young people say the centres are not youth-friendly.

“Most teenagers stay away from these places, saying they are congested with adults,” said Mavis Chigara, coordinator of the Young People AIDS Network in Zimbabwe’s Mwenezi district, in Masvingo Province.

In 2012, her organisation surveyed 12,500 young people in the district; only five percent had tested for HIV. 

“Testing for HIV amounts to seeking a death warrant, and taking ARVs is a lifelong burden,” said 19-year-old Terrence Changara, from Harare’s low-income suburb of Highfield.

Stigma plays a role. In spite of a widespread epidemic and massive treatment programmes and information campaigns, pockets of discrimination remain.

“My two boyfriends speak mockingly about people who suffer from HIV/AIDS,” said Mlambo. Their attitude indicates they must be AIDS-free, she explained, or they would otherwise be kinder.

The 2011 DHS found prevalence rates of nearly four percent for young males and just over six percent for young females. Census data estimates 3.1 million youth aged 15-24 in the country.

 Benefits of testing

Testing can be scary, and disclosing to a counsellor that one engaged in risky sex may be embarrassing, but the advantages are many.

“It is important for young people to know their HIV status because it will enable them to start treatment early and improve their health,” said Judith Sherman, HIV/AIDS specialist for the U.N. Children’s Fund in Zimbabwe.

“For older adolescents, it will reduce the risk of passing on the virus to another person,” she added. “Finally, it helps adolescents who do not have HIV to keep themselves from being infected.”

In spite of fear, four out of 10 sexually active girls aged 15-19 reported taking an HIV test in the last 12 months, according to the DHS. But one frequent reason for testing is that the girls got pregnant and are attending antenatal clinics.

“Going for HIV testing is rare among teenagers,” said Mandy Chiwawa, an AIDS counsellor in Harare. “They really need support to get tested.”

Nonetheless, more people aged 15-24 are testing, compared to the 2006 DHS. The percentage of sexually active young males who have tested tripled to 23 percent, while females increased five-fold to 45 percent.  This is higher than the regional average of 22 per cent for females and 14 percent for males.

Still a long way to go, still many Mlambos who need help to overcome their fear, but the trend is encouraging.

*Not her real name