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.”

Eighteen-year-old Maureen Phiri from Malawi knows first-hand about the loneliness of HIV. At age 12, she discovered her HIV status but did not tell her mother. Courtesy: Martina Schwikowski

By Martina Schwikowski
JOHANNESBURG, Dec 6 2013 (IPS)

Maureen Phiri, 18, has a soft voice and a strong message about HIV and young people in her country. “In Malawi, people are still in denial because of cultural beliefs. Traditional leaders and churches are denying the disease. Let us gather those leaders and hear from young people what is really happening.”

Phiri, an activist who lives with HIV, belongs to the Baylor Teen Club in Lilongwe, Malawi’s capital. The club is part of a programme that provides medical care and psycho-social support to HIV-positive adolescents, of whom Malawi has 91,000.

Phiri works hard to overcome the stigma still attached to HIV among her peers. “Only then we will be able to have an AIDS-free generation,” she told IPS.

Phiri was speaking at a forum held in Johannesburg last week, where the United Nations Children’s Fund (UNICEF) presented its Sixth Stocktaking Report about Children and AIDS, entitled “Towards an AIDS-free generation”.

It reveals alarming trends: worldwide, AIDS-related deaths among youth aged 10-19 increased by 50 percent between 2005 and 2012, from 71,000 to 110,000.

This is the only group where AIDS-related deaths have increased, in stark contrast to progress made in preventing mother-to-child transmission, with more than 850,000 new childhood infections averted in low- and middle-income countries in 2012.

The rise in AIDS-related deaths among youth shows that they are falling through the cracks of HIV programmes mainly designed for adults or children. Many adolescents do not know they are HIV-positive, others lack family support to disclose and start treatment, and some start treatment but quit and die.

An alarming trend

In 2012, some 2.1 million adolescents were living with HIV. Of these, 80 percent live in sub-Saharan Africa, says the report. Worryingly, one-third of new infections occur among youth aged 15-24.

“How did we get here? We became complacent,” said Dr. Gabriel Anabwani, executive director at the Baylor Children’s Clinical Centre of Excellence in Gaborone, Botswana.

With an HIV prevalence of 23 percent among a population of two million, Botswana has 7,800 HIV positive adolescents aged 10-19.

The centre reaches teenagers by taking their services to the communities. “HIV is a family disease, so we have to reach out to the families and educate them at home,” Anabwani told IPS.

Disclosure within the family is key and the burden should not be left to the mother alone, who is often “scared to be stigmatised or to be divorced.”

In Lilongwe, Phiri knows first-hand about the loneliness of HIV. At age 12, she discovered her HIV status after she tested with her sister. But Phiri did not tell her mother, who was in denial of being HIV-positive. Phiri had never had sex so she figured she had been born with HIV – yet the daughter was afraid to tell the mother.

She looked for help at her church and was told to trust God. “I relied on God, did not take my pills, and became so sick that I had to go to hospital,” she told IPS.

Later, a boyfriend told her neighbours she was HIV-positive, and she experienced rejection in her community.

Phiri then sought help at the Baylor clinic in Lilongwe. Its staff helped her family learn about HIV and deal with disclosure.

Missing links

Now a strong, confident young woman, Phiri told IPS, “There are no condoms at school and no health centres where we can go for testing.”

Rick Olson, senior HIV prevention specialist for UNICEF in East and southern Africa, agrees: “We are denying that young people are sexually active.”

What is needed, he added, is “a redefinition of services specifically for adolescents:  more condom distribution, more counselling, more clinics and more advice on male circumcision.”

Uganda earned world praise for successfully implementing the ABC policy – abstain, be faithful, use condoms – that brought the country’s HIV infection rate down from a two-digit rate in the 1990s to today’s seven percent.

“But we missed to drive it further into the new generation,” Specioza Wandira-Kazibwe, the Uganda-born U.N. Secretary-General’s Special Envoy for HIV/AIDS in Africa, told IPS. Infection rates in Uganda are slowly rising after the dramatic drop a decade ago.

UNICEF warns of a shocking gender disparity in HIV infection: in 2012, two-thirds of all new infections among teens aged 15-19 were among girls. In South Africa, Gabon and Sierra Leone, eight out of 10 new infections among teens aged 15-19 are girls.

Social and economic inequalities drive girls’ vulnerability to HIV – among them poverty, violence, transactional sex, early marriage, poor information and low risk perception.

“It is a challenge for leadership to move and do the right thing,” said Steven Allen, UNICEF’s regional director for central and East Africa. “We are speaking a language this generation does not understand.”

The dream of an AIDS-free generation will remain a slogan unless ways are found to reduce HIV infection among young people, especially among girls.

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

“Being in isolation to me felt like I was on an island all alone, dying a slow death from the inside out,” said “Kyle B.” from California, who was placed in solitary confinement before he turned 18.

Lois DeMott visits her son Kevin, age 20, at the Woodland Correctional Facility two weeks after his release from a prolonged stay in solitary confinement in 2012. Credit: Human Rights Watch

Thousands of young detainees are being held in solitary confinement in jails and prisons across the United States, for weeks, months or even years with virtually no human contact or meaningful motivation, according to a joint report by Human Rights Watch (HRW) and the American Civil Liberties Union (ACLU) released Wednesday.

The report, entitled “Growing Up Locked Down”, investigates jails and prisons in states such as Colorado, Florida, Michigan, New York and Pennsylvania, among others, and is based on interviews and correspondence with more than 127 young people subjected to solitary confinement, as well as prison officials.

“Locking kids in solitary confinement with little or no contact with other people is cruel, harmful and unnecessary,” said Ian Kysel, Aryeh Neier Fellow with HRW and the ACLU and author of the report.

“Normal human interaction is essential to the healthy development and rehabilitation of young people,” he added.

The HRW and the ACLU estimate that, as of 2011, roughly 95,000 adolescents were kept in prisons and jails, comprising a large number of young inmates nationwide who find themselves in conditions of solitary confinement on a daily basis.

Out of 127 investigated young detainees, 49 have reported spending between one and six months in isolation while under age 18, while 29 said that they spent longer than six months in solitary confinement.

“Procedures and conditions for holding young people in solitary confinement vary from facility to facility and state to state,” Kysel told IPS, adding that the problem of solitary confinement affects both young men and women.

“Many facilities use it to protect young people from adults. Because there are fewer girls than boys in the adult criminal justice system, officials may be more likely to have only one girl in their jail, for example, and hold them in solitary because they feel they have no other option. But there is never a justification for holding a young person in their cell for 22 or 24 hours at a time,” Kysel added.

Numerous psychiatric studies show that long-term solitary confinement causes serious and devastating consequences, which range from mental diseases to physical health problems, undermining the process of rehabilitation for adolescents and even increasing the risk of suicide, the report warns.

Several imprisoned adolescents interviewed for the report said they had considered suicide while in solitary confinement.

They also repeatedly reported how isolation compounds the harm of being in jail or prison per se, describing cutting themselves with staples or razors, having hallucinations, and losing control or losing touch with reality while held in solitary confinement.

Moreover, young people are consistently denied visits by their parents as well as access to treatment, basic services and educational programming to cope with their psychological, medical and social needs. As people under age 18 are still developing, traumatic experiences such as solitary confinement may harm their development and rehabilitative potential.

A video produced by Human Rights Watch contains first-hand testimonies from young detainees as well as their families.

Prison isolation reflects the definition of torture as articulated in different international human rights conventions, such as the United Nations Convention Against Torture that defines it as any act “by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” to obtain information, punish for an act, intimidate or coerce, or for any reason based on discrimination.

The 141-page report offers many alternatives and recommendations to address the issue, ranging from disciplinary to administrative, protective or medical ways of treatment, while taking into consideration the rights and special needs of adolescents.

According to the report authors, young people can be better managed in “specialised facilities, designed to house them, staffed with specially trained personnel and organised to encourage positive behaviors”.

Using any short-term isolation should be a rare exception. Moreover, placing young people in correctional facilities designed to house adults should be strictly prohibited.

“In the past decade, the United States Supreme Court has repeatedly acknowledged that in the criminal justice context, youth are entitled to greater constitutional protections than adults,” the report states.

But “there is not currently a case pending before the Supreme Court on solitary confinement of juveniles,” Kysel told IPS, adding that, however, in a string of cases in recent years the court has said that for the purposes of crime and punishment, children are different and their youth must be taken into account.

“In July, the U.S. Senate Judiciary Committee held the first-ever hearing on solitary confinement. This is a national problem and could effectively be addressed by a federal ban,” he said.