Back Issues

Introduction to power, politics and AIDS in Africa

Stephen Lewis & Paula Donovan

2008-12-02

http://pambazuka.org/en/category/features/52374

cc. Flickr.comThe invitation to guest-edit a special issue of Pambazuka News wasn't something we pondered at AIDS-Free World; it's something we pounced on. We consider Pambazuka a precious commodity: a consistent source of timely, credible, thought-provoking, expectation-defying news and views. Our subscription has helped keep us informed and made us better at what we do, which is to push and prod for more urgent and more effective global responses to AIDS. And so we snatched at the opportunity to be involved in an issue devoted to HIV/AIDS, and our Political Advisor, Gerry Caplan, began working with the Pambazuka staff to solicit articles and essays about the most confounding of the African pandemic's unsolved problems.

The topics covered in this issue aren't naturally uplifting. Whether it's the world's persistent blind spot concerning TB and that disease's morbid attraction to HIV; a seemingly universal ignorance about people with disabilities that places 10 per cent of the human population at heightened risk of contracting the virus; or evidence that Zimbabwe's government orchestrated a campaign of sexual violence for political ends, and will likely do so again while the world stands by, the issues underlying HIV/AIDS are not for the faint of heart.

But in the 18 months since we started AIDS-Free World -- an advocacy organization with a mission to speak up and speak out, to challenge authority and demand responsible leadership, to subject the status quo in AIDS prevention, treatment and care to unflinching critique, to build not only awareness but impatience and outrage over unnecessary suffering -- beyond what has seemed like a mountain of inertia and indifference, we have also glimpsed countless reasons to be hopeful. You will read about some of them in this issue, too. One is the long-awaited recognition by UN member states that the world body has failed women -- not least by allowing worldwide gender inequality to give rise to an explosive AIDS pandemic -- and a current move to create a new UN agency for women. Another is the small but hopeful indication that beneath a surface of machismo, and with the right prodding, significant numbers of men are actually as anxious to be free of the cycles of violence against women as women are themselves.

We wish Pambazuka News continued success as it explores and exposes the issues that present Africa with its AIDS-related trials and triumphs. AIDS-Free World will also keep poking and prodding, unafraid to analyze, assess, critique and take principled stands. We invite you to visit our website at www.aids-freeworld.org, where starting next month, you'll find our 2-minute daily video commentaries on the AIDS-related news of the day. It was a privilege to contribute to Pambazuka's World AIDS Day issue, and it's an honor for AIDS-Free World to count ourselves among this special news service's informed, inquisitive readership.

* Stephen Lewis and Paula Donovan are Co-Directors of AIDS-Free World

* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/

An AIDS-Free World travel diary: On the road to a new UN agency for women

Julia Greenberg

2008-12-02

http://pambazuka.org/en/category/features/52367

cc. Reza VaziriIn September of this year, UN member states passed a resolution to move swiftly to create a new UN agency for women, a move, packaged with a series of reforms on governance and funding, that they hope will result in renewed public faith in the UN system. Julia Greenberg, AIDS-Free World’s associate director, tells the inside story behind the sudden groundswell in support for the new women’s agency and why the global community of women living with, and affected by HIV/AIDS, should care.
AIDS-Free World’s call for a complete overhaul of the UN’s response to the rights and needs of women in began 2005 when Stephen Lewis and Paula Donovan, our co-directors, and then the team that drove the work of the office of the UN Special Envoy for HIV/AIDS in Africa, began mentioning the limitless potential of a new women’s agency in all of Stephen Lewis’s speeches about the horrendous impact of AIDS on the women of Africa. In 2006, gender equality found its way onto the agenda of the UN reform process spearheaded by Kofi Annan, due largely to the high level advocacy of the Envoy Team combined with the community mobilisation and tireless activism of a global coalition of women’s groups called the GEAR campaign (Gender Equality Architecture Reform). The envoy team’s public statements about the UN’s woefully inadequate women’s programmes (the combined annual budgets for all of the UN agencies concerned with gender totalled US$65 million in 2006, while UNICEF’s budget was US$2 billion), and intensive lobbying of members of the High Level Panel tasked by Annan to recommend a series of reforms on ‘system-wide coherence’, helped lead to a concrete recommendation for a wholly new women’s agency, ambitiously funded, with operational capacity at the country level, headed by an under-secretary general.

Since this recommendation was made, the proposal for the women’s agency has been caught up in political wrangling among member states over other reforms recommended by the High Level Panel on such issues as governance and funding. These are critically important issues, especially for poor countries in the Group of 77 block (G77) who live with the destructive legacy of the conditions, such as structural adjustment programmes, that have been imposed upon them by the World Bank and the IMF. While we did not (and would never) play down the impact of this damaging legacy, we bridled at the contention of many G77 countries that that the proposal for the women’s agency was, in effect, a condition imposed on them by donors. Moreover, we lamented the lack of will and leadership in the secretariat, who seemed more concerned with hanging on to jobs they might lose in the proposed new structure than with upholding the core values of equality enshrined in the UN charter.

And so ambassadors and UN officials continued to talk and the proposal for the women’s agency languished. And during that very same time period we saw the rape of hundreds of women in Kenya during post-election violence with no UN agency to address their specific needs, a prolonged battle within UNAIDS to come up with coherent gender guidance for member states, which was only issued in April 2008, just before the secretary general reported that 61% of the populations in sub-Saharan Africa infected with HIV were women.

In January 2008, we began to see signs of life when the new secretary general, Ban Ki-moon, appointed two new co-chairs, Augustine Mahiga, the ambassador from Tanzania, and Paul Kavanagh, the ambassador from Ireland, to resurrect the system-wide coherence process, and thus, the proposal for a new women’s agency. Mahiga and Kavanagh have proven to be shrewd and tireless stewards of the reform agenda. They recognised that they had to significantly narrow the scope of the High Level Panel’s recommendations in order to achieve consensus, and as such they informed the General Assembly that they would convene a series of ‘Informal Consultations’ (General Assembly meetings) on four aspects of the High Level Panel’s recommendations: 1) ‘Delivering as One’ (an attempt to streamline the on the ground operations of UN country teams); 2) governance 3) funding; and 4) gender.

A TWO-DAY TRIP FROM INDIA TO LIBERIA AND MANY COUNTRIES IN BETWEEN

Beginning in April, Stephen Lewis and I, on behalf of AIDS-Free World, embarked on a global quest to encourage UN ambassadors, especially those from the G77 block, to speak out in support of the women’s agency at the two informal consultations on gender scheduled for May and June. We knew that the only hope for a consensus in the General Assembly was if developing country voices added their demands to the chorus of donor countries, specifically the northern Europeans, who had been very vocal in their support.

A UN mission reflects, with almost uncanny accuracy, the position and condition of the country it represents. A visit to India involves being led by several polite aids, through a series of interconnected rooms, each with beautifully appointed artwork and rugs, into the inner sanctum office of the ambassador. By contrast, the missions of the poorest of the sub-Saharan African countries boast broken elevators, faulty air conditioners, and often require walking up four or five flights of stairs of a rickety brownstone, un-strategically located several blocks from the UN.

INDIA

Anticipating resistance to our appeals from India, a powerful presence in the General Assembly, we were encouraged by what we heard during our visit. Over tea, India’s brilliant and provocative Ambassador Nirupam Sen assured us that there was almost unanimous agreement among developing countries that a new women’s agency was needed, but that it was necessary to finesse the politics. The main concerns of poor countries, he told us, were around governance. The G77 is interested in strengthening the UN’s technical assistance and financing functions, while northern countries like the United States are more comfortable with this power in the hands of the Bretton Woods institutions – the World Bank and the IMF. He rejected the notion that the G77 was holding the women’s agency hostage to negotiate for other reforms, and asserted that the system-wide coherence exercise was in fact essential to the UN – a UN that was relevant to the realities of the countries on the poorer half of the planet.

LIBERIA

We were greeted by the extremely impressive and kind Ambassador Milton Nathaniel Barnes whose mission consists of a barely-furnished, two-room office with a staff of three. His Excellency actually ran for president against Ellen Johnson-Sirleaf, who after defeating him, appointed him as her man in New York. Proudly representing a nation led by the first democratically elected woman in Africa, he told us that Liberia’s role at the UN required being out in front on the questions of gender. Given the paucity of staff and funding for the mission at this time of transition in Monrovia, he was grateful that we reminded him of the time and date of the consultation on gender, and he assured us he would be happy to speak in support of the women’s agency. We proceeded on to visits with Jordan, Brazil, and Kenya, and again heard that support for the women’s agency was widespread, but that the complexities of negotiating the extensive package of reforms would be the greatest obstacle to its coming into existence.

THE FIRST INFORMAL CONSULTATION ON GENDER – 16 MAY 2008

On the crisp May afternoon, I quickly flashed my UN pass (which does not allow me access to closed informal consultations) to the distracted guard posted at conference room four, and found a seat in the observer section. The co-chair from Tanzania began the discussion: ‘The co-chairs sense a widespread commitment to the objectives and actions agreed in Beijing in 1995 and reiterated on numerous occasions since then. It is therefore fully understandable why the High Level Panel sought to make recommendations which in their view would enhance the UN's ability to achieve these… To use a summary phrase: gender is development. We have heard this constantly during our widespread consultations. Our purpose in advancing system-wide coherence is to attain better and more effective delivery of development to all sections of societies in need.’ Not a bad start.

The G77 again raised the issue that ‘The gender issues should not be misused to introduce new conditionalities on international development assistance.’ Carefully scrutinising every word, my heart leapt when the statement introduced the word ‘misuse’, the implication being that there might be scenario by which a gender reform could be used correctly.

As the hours (yes, three of them) passed, my heart sank, as none of the African ambassadors who indicated to us that they would speak in support of the women’s agency did so. Relief came, however, in the form of strong statements about the weaknesses of the UN on gender by Mongolia, Albania, Bangladesh, all including requests for the secretary general to produce a note presenting his views of how the UN could better deliver on its commitments to gender. Kazakhstan said it best: ‘Almost two years passed after the report of the High Level Panel on system wide coherence recommended new gender architecture that would be able to bridge the system’s gap between policy and implementation and be accountable for the outcome. The panel’s proposal to consolidate mandates of OSAGI, DAW and UNIFEM into one entity led by an under-secretary general that would assume full responsibility for strategic planning, normative and operational functions is still a proposal on paper. While one of the most flashing issues that concerns 50% of the world population is still beyond the secretariat’s action. In this regard, my delegation would like to request secretary general to get finalized the negotiations with members states on the structure and working methods of the gender entity that would play a leadership role to assist the governments in reaching gender equality worldwide and commence running the entity.’

The co-chairs ended the meeting by requesting that the secretary general heed the requests of the member states to produce a report on the UN’s work on gender, for discussion by member states in one month’s time. Interestingly, no one baulked at the fact that gender warranted two consultations, while funding and governance only got one each. We hoped that our powers of persuasion would compel African ambassadors to suggest that a new women’s agency was exactly what was needed to address the weaknesses that would be laid out in the secretary general’s paper. We awaited release of the report, and scheduled another round of meetings with ambassadors.

FROM RWANDA TO ZAMBIA: AFRICAN AMBASSADORS TAKE THE LEAD – 2 JUNE 2008

RWANDA

From the moment we sat down with the His Excellency Joseph Nsengimana, it became clear that the debate on the women’s agency had been fast tracked. Governments like Rwanda, with impressive records on gender equality (Rwanda has more women in parliament than any other country on the planet) saw the future women’s agency as an opportunity to enhance its presence and clout within the UN system. The ambassador was so confident that the women’s agency would come to be, that he had submitted CVs of excellent Rwandan candidates for senior posts in the new structure.

ZAMBIA

We heard similar stories from Namibia and Lesotho, and ended the day on a high note during our visit with Ambassador Lazarous Kapambwe. Finally, he claimed to have called for the ‘creation of the unit’ before the system-wide coherence process even started, and suggested that we lobby key countries willing to make the women’s agency the ‘flagship issue’ of the upcoming session of the General Assembly.

THE SECOND INFORMAL CONSULTATION ON GENDER – 16 JUNE 2008

The report on the state of the UN’s work on gender was issued by the deputy secretary general on 5 June, and detailed weaknesses in the areas of coordination and coherence, authority and positioning, accountability and resources. It hit all the bases, and laid the groundwork for clear calls for reform which, this time around, the member states took up with what can only be described as gusto.

From Liberia: ‘Gender equality and women’s empowerment are key pillars in the quest for peace, stability, and economic prosperity. The rights of empowerment of women…are critical building blocks that support the structure of effective statehood… It is clear and obvious that we are morally and philosophically bound to new mechanisms on gender equality and women’s empowerment.’

From Rwanda: ‘It is in our common interest to strengthen the capacity and effectiveness of the UN’s work advancing women’s empowerment and gender equality at country level as a matter of priority before the end of the 62nd session [of the General Assembly this September].’

From Benin: ‘We know how much is still left to be desired in promoting the rights of women. The UN must strengthen its capacity to contribute to solutions. Assistance must become more effective and pressure on states must be more intense and sustained to loosen the grip of traditions that subjugate women. We must without haste, establish the entity that is being proposed. It’s urgent that women take their rightful place in the life of nations and achievement of the millennium development goals.’

And the co-chair from Tanzania took his very obvious cue and concluded with the following remark: ‘We have heard loud and clear from the membership a strong desire to address effectively the manifest weakness of the UN system in the area of gender equality and women’s empowerment. We detect an unmistakable and broad-based momentum in this direction. The co-chairs believe that in light of the foregoing, we are now in a position to ask the secretary general, by mid-July, to produce a second paper which would focus on the institutional dimension of gender. The secretary general could be asked to present, in a non-prescriptive manner, a range of options to help the UN help improve its gender equality and women’s empowerment work.’

And so the game had changed. We had moved on to brass tacks – an actual structure for the women’s agency. We were determined to understand why, suddenly, a resistant, male-dominated institution had so completely changed its tune on gender reform. So we asked the ambassador from China.

FROM CHINA TO TANZANIA: THE WOMEN’S AGENCY BECOMES THE WINNING ISSUE ¬– 9 JULY

China: We were delighted that Ambassador Liu Zhenmin agreed to meet with us on the very day that he was concerned with important Security Council matters such as the proposed sanctions against the Zimbabwean government after last month’s stolen elections (which they would veto). Considering China’s statement at the June 16th Informal Consultation on Gender, we weren’t expecting an open embrace of gender reform: ‘China believes that strengthening the existing institutions and the Inter-agency Working Group on Gender and Women’s Empowerment should be considered an option. There is no evidence to show that a new entity will solve these problems.’

Sitting on the white leather couches of the Indonesian lounge surrounded by clusters of ambassadors in heated acts of diplomacy, we asked the ambassador, why, suddenly was there so much momentum in support of the women’s agency among member states? His response was simple and clear. Of all the reforms brought forward for discussion by the co-chairs, Ireland and Tanzania, the proposed women’s agency is the ‘easiest issue they are promoting.’ He proceeded to explain, quite presciently, that it would not be the governments that would block progress, but the existing agencies focused on women’s issues: ‘Each will want dominance in the new structure.’

His analysis did not imply blanket support from China, but it did confirm our suspicion that even the most powerful and sometimes obstinate voices among the member states had come to believe that it was unlikely that the General Assembly would turn their backs on this reform. It would be ‘easier’ to resolve the issue of the women’s agency than those related to funding or governance. A decision on this one reform would at least demonstrate a modicum of progress in the system-wide coherence process.

Tanzania: Much was revealed about the remarkable progress on the women’s agency during our meeting with His Excellency Augustine Mahiga, the ambassador and co-chair from Tanzania. He openly shared the intricate, thoughtful and exhaustive strategy that he and Ambassador Kavanagh of Ireland had pursued to promote constructive engagement by member states in the system-wide coherence process, particularly the gender issue. He raised the following key points during our 90 minute meeting.

He and Kavanagh knew that support for the women’s agency had to come from the bottom up. They travelled to several developing countries and were able to report back to resistant member states that governments had become impatient with the slow pace of the UN in pushing forward gender policies. It was during their field investigations that they heard the phrase ‘gender issues are development issues.’ He believed that given the member states’ preoccupation with strengthening the UN’s development functions, that this phrase would have lasting resonance and traction.

The co-chairs also recognised that while it was okay for gender issues to be development issues, it was distinctly not okay for gender issues to become a Trojan horse for human rights issues. The High Level panel’s recommendations related to human rights would most definitely have been taken as conditionalities by member states, so the co-chairs quietly dropped them from the discussion, noting that the Human Rights Council in Geneva was the appropriate body for these issues. According to Mahiga, he could feel the member states breath a ‘collective a sigh of relief.’

He concluded our meeting with the following statement. ‘Resources are dipping for development activities through the UN, but its convening power is unique and its leveraging power increased if it is efficient, effective and people can trust it.’ To that, we chimed in, ‘AIDS-Free World would argue that in light of what the you just said, the UN needs women.’

‘That is an understatement’, he replied, echoing the chorus of the many male African ambassadors suddenly championing the cause of the world’s women from Rwanda to Zambia: ‘If we have women there, that is where the salvation lies. We are depriving the world of half of its riches.’ We couldn’t have said it better ourselves.

AUGUST THROUGH SEPTEMBER: A DECISIVE MOMENT?

Immediately before the 62nd General Assembly, the deputy secretary-general produced what has become known among the community of NGOs with whom we have been working to promote the women’s agency as ‘The Options Paper’, delineating a range of possible structures for a new UN agency for women. Among the options suggested are: 1) Maintaining the status quo; 2) Simply combining the existing, fragmented agencies; 3) Creating a new composite organization that will combine normative and operational functions; and 4) an autonomous fund or programme.

When the paper was released in July, the member states convened, remarkably, for their third discussion on gender equality and women’s empowerment in three months and requested that the deputy secretary general further elaborate on the options presented, with a particular focus on the composite entity. Two months later, member states adopted, by consensus, a resolution to take ‘substantive action’ on the women’s agency in its next session.

SIGNIFICANCE OF A NEW WOMEN’S AGENCY FOR THE AIDS MOVEMENT

If any movement knows how to mobilise communities to demand that the international community create institutions that respond to their needs and rely on their expertise, it’s the AIDS movement. UNAIDS is one of the few UN bodies whose governance structure includes NGOs and people living with AIDS as permanent board members. If it was not for the tireless work of AIDS activists in the late 1990s through to the early 2000s, the Global Fund for AIDS, TB, and Malaria would not exist, and certainly would not have the innovative mechanisms for civil participation that currently help drive its policies and operations.

But let’s not look at these institutions through rose-tinted glasses. Even with civil society participation in UNAIDS and the Global Fund, the international community’s response to the impact of HIV/AIDS on women can only be characterised as a failure. The statistics tell the story: women comprise 61% of women living with AIDS in sub-Saharan Africa; AIDS is the leading cause of death among black women in the United States aged 25–34; only 34% of the world’s women have access to a simple therapy to prevent transmission of the virus to their children – the global target set in 2001 was 80% coverage. Data on the links between HIV infection and conflict-driven sexual violence is practically non-existent. What we do know is terrifying. For example, UNAIDS reports that the HIV prevalence rate in Democratic Republic of Congo is between 1.7% and 7.6 % depending on the region, and may be as high as 20% among women who have been raped in the conflict-riddled east of the country.

Women working at the community level to cope with the devastating impact of AIDS know instinctively that women’s vulnerability begins at birth and continues when the boy-child is the first to receive school fees, when girls are circumcised and married off early, when domestic violence explodes, and when girls are conscripted into wars as fighters and sexual slaves. That is why women-led AIDS programmes around the world deal not only with prevention and care, but with human rights training, inheritance and property rights protection, and advocacy to abolish hidden school fees. And, it’s always the case that these effective and innovative programmes are constantly struggling for recognition and funding.

A women’s agency with significant resources and visionary leadership could support these kinds of programmes and fill other huge holes in the UN’s AIDS response. To name a few: there is no single agency representing women’s issues among the co-sponsoring organisations of UNAIDS (UNIFEM reports to UNDP, so is not represented directly); UNICEF touts as a success the fact that globally 34% of women who need prevention of vertical transmission therapy have accessed it, but says little about the fact that these same women face significant barriers accessing treatment for themselves. Today, when a conflict erupts, gender experts are evacuated as ‘non-essential staff’, and as a result rape prevention and post-rape treatment (including post-exposure prophylaxis) are rarely implemented as part of the emergency response.

It may be too much to ask to expect women, who already heroically carry the lion’s share of the burden of the AIDS response on their backs, to divert what precious little of their energy remains to demanding a role in a new UN women’s agency, but if they did, there is no doubt that the UN would be infinitely stronger for it.

THE MONTHS AHEAD

Unlike many of the ambassadors with whom we spoke, of course AIDS-Free World does not support this particular UN reform simply because it’s winnable. And of course we believe that women’s rights are human rights, and that human rights should be central to every aspect of UN reform. But we vastly prefer the current language coming from member states about gender equality as a moral and ethical imperative, than the language of donor-imposed conditionality. We will try to hold them to their statements.

If in the 63rd session of the General Assembly, ending in 2009, the proposal for the women’s agency stalls again, AIDS-Free World and our allies in the women’s and AIDS movement will loudly and publicly question whether the UN has the credibility to speak on behalf of women at all. If the proposal pushes through, that is when the work will really begin. The time will have come to demonstrate to the honourable co-chair from Tanzania, that indeed, if women are there, that is where the UN’s salvation truly lies.

Stay tuned.

* Julia Greenberg is [url= AIDS-Free]http://www.aids-freeworld.org/]AIDS-Free World’s[/url] associate director.
* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/

The feminization of violence in Zimbabwe

Women and human rights in the post March 2008 election period

States in Transition Observatory

2008-12-02

http://pambazuka.org/en/category/features/52363

cc. SokwaneleStates in Transition Observatory look at the Zimbabwe’s botched election and the subsequent violence, and how this has specifically affected women. They underscore the fact that in times of crisis and conflict, such as those still being witnessed in Zimbabwe, it is always the women and children who are most victimized. The case of Zimbabwe shows how women suffer, both for perceived direct participation in the political process, but also by proxy, for their husbands’ or family members’ involvement. In Zimbabwe, as in other conflict areas, sexual violence continues to be a tool of war.
In times of war and political crises women and girls, mostly civilians, become targets of violence. “A feature of these conflicts is that the civilian population is increasingly ‘caught up’ in the conflict or even deliberately targeted by parties to the conflict. In this context women and girls are exposed to acts of violence, often resulting in death and injury from indiscriminate military attacks. During armed conflict, women and children are more likely to be subjected to mysterious disappearances, hostage-taking, torture, imprisonment, sexual- and gender-based violence, forced recruitment into the armed forces and displacement” (Koen, 2006:1). As a consequence, many women are faced with a long term struggle with trauma and HIV/AIDS.

Violations of women's human rights are widespread in a number of countries on the African continent. A distressing example is Zimbabwe, where politically motivated wanton abuse has been more pronounced than in most hot spots on the continent. This violence surged in the aftermath of the 29 March 2008 elections, in which ZANU-PF lost its majority in parliament for the first time since independence in 1980 [1]. In the presidential race, Robert Mugabe came second to the opposition party, the Movement for Democratic Change (MDC), leader Morgan Tsvangirai [2]. A presidential run-off ballot was deemed necessary as neither candidate achieved the 50 percent plus one vote required for an outright win.

Despite being given free food, grain, farming implements and fertilizer by the incumbent regime before the March 2008 elections, Zimbabwe's rural areas, once viewed as strongholds of the ruling ZANU-PF party, backed the opposition Movement for Democratic Change (MDC). This move by the rural folk resulted in some senior government members losing their parliamentary seats in a number of provinces. As a result, the period prior to the run-off election was marked by extensive violence, torture and internal displacement of the electorate believed to be supporting the opposition. The aim was to target potential MDC activists and leaders at different levels. Massive human rights violations committed in the post election period include: unlawful killing of civilians, torture, rape, abductions, destruction of villages and property, looting of cattle, grain and property, the destruction of the means of livelihood of civilians and forced displacement.

Although many Zimbabweans became victims, this paper looks at women who suffered during the post-election violence. Women in Zimbabwe have been assaulted, tortured, and sexually harassed. In some instances, they were the direct victims of violence and in others, they bore the brunt of the impact of the violence as male opposition party supporters fled the rural areas; leaving women more vulnerable and with the burden of providing for families in the midst of the worsening economic and humanitarian crisis. In addition, in an attempt to force the men to return to the rural areas, the ruling party (ZANU PF) militia frequently abducted women and children and held their men folk to ransom. Women were harassed because their husbands, sons or male relatives were suspected of being supporters of the opposition party. Female candidates and activists were also victims of the violence. Leaders at local levels, social workers and health advisors who worked to support female MPs were also targeted.

INTRODUCTION

The link between election results and election violence can be found in Operation Makavhotera Papi [where did you put your vote?]- a program that saw war veterans, soldiers, militia, intelligence operative and ruling party youths inflicting retribution on suspected supporters of the opposition in both rural and urban areas (Zimbabwe Peace Project, 2008). Post election violence resulted in numerous instances of rape and other forms of sexual violence in Zimbabwe.

The primary focus of this paper is sexual abuse in the post election period in Zimbabwe and its impact on women’s lives. The paper includes personal testimonies and discussions of the impact of sexual abuse, the culture of impunity and the lack of institutional support. Having outlined different ideas about what motivates rapists in conflict situations, it discusses post-traumatic assistance needs and the social responses to rape. It highlights the need for both economic support and means to address psychological trauma for women who survive rape and further discusses some of the efforts made in this direction.

Primary data for this research was collected through a series of interviews with civil society organizations from Zimbabwe and eighteen Zimbabwean women and girls who were abused during the post election period [3]. The Zimbabwean women interviewed were very reluctant to talk about rape, for fear of being ostracized or increasing the security risk for their communities. Through the testimonies, this paper attempts to document, expose and call domestic and international attention to women’s experiences of sexual violence in the post election environment in Zimbabwe. Deeper insight into the various aspects of sexual violence in conflict and post conflict situations and its consequences for women’s health can contribute to the development of more appropriate legal instruments, policy formation and support for the affected women.

NAIROBI DECLARATION

In May 2007, the Nairobi Declaration on Women’s and Girls’ Rights to Remedy and Reparation was drafted in the belief that justice for women and girl survivors of sexual violence will never be achieved if reparations programmes are not informed and directed by those they are meant to serve. The Declaration is founded on the experiences of women and girl survivors of sexual violence and the expertise of activists helping them to rebuild their lives (Chitsike, 2008). The Nairobi Declaration informs this study because it directs attention to:

* Empowering women and girls, support their efforts to rebuild trust and relations and foster their participation in social reconstruction.

* Decision-making about reparations must include victims as full participants;

* Addressing social inequalities and discrimination in existence prior to conflict, which lie at the root of violence against women and girls in times of conflict;

* Promoting social justice and encourage the transformation toward a fair and equal society;

* Emphasizing the importance of truth-telling in order to allow women and girls to move ahead and become true citizens. Abuses against women must be named and recognized in order to raise awareness about these crimes and violations, to positively influence a more holistic strategy for reparation and measures that support reparation, and to help build a shared memory and history.

It is recognition of these issues that underpins the fundamental principles of reparations for sexual crimes, truth and reconciliation. Through the testimonies, this paper raises awareness about the sexual violations and abuses that were perpetrated against women.

MOTIVATION OF PERPETRATORS

The sexual attacks studied were motivated by political factors. Youth militia and war veterans targeted, raped, abducted and enslaved women who were identified as members of the opposition group or whose families belonged to the opposition party. The perpetrators in these cases seemed to act with the tacit or explicit approval of their political or party leaders. The rebel factions used sexual violence to terrorize, humiliate, punish and ultimately force the MDC supporters and leaders at various levels into submission. Women and children paid the price for the political involvement with the opposition party of their husbands, brothers or siblings [4].

“Rape is used in armed conflict to intimidate, conquer and control women and their communities. It is used as a form of torture to extract information, punish and terrorize” (Koen, 2006:2). In several instances, women were raped and abused because they did not reveal their husband’s whereabouts. Rape included gang rape where up to eight men would rape a woman over a period of five days. Some militia indicated that they were doing it in order for the girls to bear them ZANU PF children.

In the MDC strongholds such as Manicaland and Mashonaland Central where the government had been trying to violently suppress the opposition, women and girls were raped and abused. In numerous examples, the youth militia and war veterans approached women and asked them to reveal the whereabouts of their husbands or brothers. Women were tortured and abused in order to force them to tell where their husbands were hiding. They raped them or physically assaulted them to force the males, whom they suspected to be opposition supporters, to return home.

Typically, random arrests were used to force male MDC supporters and activists to come out of hiding. This violence and lawlessness put many women and girls at risk. Youth militia who reportedly raped women in front of their families or children bragged about it in the community thereby stigmatizing and isolating the women and girls further.

In addition, acts of sexual violence were often marked by the systematic breaking of taboos and undermining of cultural values. For example, a girl of eighteen reported to have been raped by her cousin, a case of incest. Many other instances were reported where women and girls were abducted for the purposes of supplying youth militia at the bases with sexual services, cooking and cleaning. Several testimonies collected for this study contain clear cases of sexual slavery and torture.

Sexual violence was not only occurring as a by-product of the collapse of the rule of law, moral and social order in Zimbabwe brought on by the post-election conflicts. It was also used as a tool to settle scores among families and individuals and precipitate their expulsion from the communities in which they live. Most survivors did not get the care they needed following exposure to rape and other forms of sexual violence. A human rights activist explained that people had nowhere to report their immediate problems because the police were not in a position to help [5].

SEXUAL VIOLENCE AGAINST WOMEN

GENERAL PHYSICAL ASSAULT

The ZANU PF militia had a list of names of villagers; most names were those of men who had run away. Most of the listed people were listed because they held positions or supported the opposition party. These people were listed in a ‘black book’. Absent men were represented by their wives, sisters, mothers or grandmothers. These were taken out of the crowd while the remaining citizens sang and chanted liberation war songs. Against the list of names was an asterisk. The number of asterisks against one’s name signaled his/her level of political activism and this would also determine the severity of the physical attack they would receive.

General intimidation and physical assault was a common form of violence against women. Women were beaten on the back, bottom, palms and breasts using huge sticks, logs or electric cords.

In some instances, in an operation in Chiweshe, a communal area in the Mashonaland Central Province of Zimbabwe, the beating sticks would be marinated in paraquat for the two days [6]. This was dubbed Operation Paraquat. Use of sticks laced with paraquat led to the development of infection and pus underneath the skin on the bottom. This resulted in loss of all the flesh on the buttocks. Skin grafting of such wounds is not possible because of the tenderness of the skin.

SEXUAL VIOLENCE AS PHYSICAL ASSAULT

One woman reported that the youth militia raped her. They ejaculated into her mouth and urinated all over her face. Other abuses include inserting sticks into women’s vaginas. Testimonies of sexual violence indicate that rape was politically driven. The attackers tried to humiliate their "enemies". In many instances, using abusive language (opposition supporters wanting to sell the land back to the whites, reference to Britain) with anti imperialist connotations was also common.

BASES AND RAPE

It is estimated that as many as 20000 militia bases were established during the post election period, many of them at schools, community halls and farm houses. Youth militia and war veterans stayed at the bases for the duration of the presidential run off campaign period. All ZANU PF rallies were held at the bases during this time, and women were asked to cook and clean. The bases were also used to keep assaulted and tortured people who had been abducted. The women who had been abducted were also raped at the bases.

Women’s Coalition [7] estimates that at least ten women were abused at each base. It is however important to note that under reporting of rape is typical even in times of peace; worse still in times of conflict and its aftermath, when constraints such as stigma and shame are compounded by political instability and threats to personal safety. Exposing violence in the context of active conflict can represent a security risk for all involved.

MURDER

Abigail Chiroto, the wife of the newly elected mayor of Harare, Emmanuel Chiroto, was abducted from her home in Hatcliffe, Harare, and later found dead at a farm on the outskirts of the capital. Mrs. Gumura of the MDC Womens Assembly in Rusape was murdered together with her husband in Rusape, in Manicaland province. The wives of MDC officials were also victims of the violence. Dadirai Chiripo had both her hands and legs chopped off before being burnt to ashes in her hut and Pamela Pasvani died of her wounds, with her six year-old son perishing in a fire [8].

EFFECTS OF THE VIOLENCE

SILENCE

Rape is a horrendous crime that brings with it a lot of trauma, shame, ostracism and loss of dignity. As such, most women prefer not to speak about it. Many fear losing their marriages [9]. Women’s Coalition reported that most women prefer not to have their cases recorded. All they want is to be treated [10].

It is well documented that the survivors of rape and other forms of sexual violence often do not speak out. They may be at risk of harsh punishment or even death for bringing ‘dishonour’ on the family. The African cultural setup has stood against women who have been abused and tormented, they are treated as outcasts. Others may be infected with HIV/AIDS and face social rejection (Koen, 2006:2).

TRAUMA

The women interviewed for this study were very traumatized and would cry easily upon recounting their stories. Some women would also shiver as they recounted their stories, and a number indicated that they would rather not tell their story. Sexual violence against women in war and its aftermath can have almost inestimable short and long-term negative mental-health consequences.

Some rape victims are rejected by their families and communities for having “lost their value.” In the case of one young girl raped by eight youth militia for five days, the girl lost her virginity in the assault. In the interviews, the women who had been raped indicated that they had been mocked, humiliated and rejected by women relatives, classmates, friends and neighbours because of the abuse they had suffered. Some marriages are breaking down as husbands fear contracting HIV, or simply cannot tolerate the fact that their wives had been raped.

Ironically, and sadly, women and girls who experience sexual violence during conflict are probably the most vulnerable of all to further exploitation in post-conflict settings.

MEDICAL IMPLICATIONS

Women and girls who have suffered sexual violence have a full range of health needs that need to be addressed. These include treatment of injuries that may have occurred in the course of the sexual violence, information and preventative treatment for sexually transmitted diseases, information and access to services to prevent or terminate unwanted pregnancies, and counseling services to address the emotional and psychological impact of rape.

Rape can result in numerous medical consequences, including internal bleeding, and infection with sexually transmitted diseases such as HIV/AIDS [11]. The majority of the women did not receive treatment for exposure to HIV in the form of Post-Exposure Prophylaxis (PEP) [12].

DISPLACEMENT

During the attacks, hundreds of homes were burnt to the ground by ZANU PF militia. Property destruction and looting led to internal displacement. This led to psychological trauma, feelings of anxiety, fear, terror and hopelessness. Women lost grain, goats, cows and chickens. Houses were burnt while women had escaped to hide in the mountains.

The Movement for Democratic Change (MDC) estimated that as many as 200 000 people were displaced countrywide. Many of the displaced people fled to Harvest House (the MDC Headquarters) with the majority being women and children. Women’s Coalition reports that internally displaced persons (IDPs) started coming into the cities about four weeks after the violence started. Most women had escaped to the mountains and upon realization that their houses had been destroyed, they left for the city.

ASSISTANCE

Zimbabwe Doctors for Human Rights, The Counseling Services Unit and other private medical centers provided help and continue to provide help to victims. Some Mission hospitals also played a major role in providing medical assistance to victims. State hospitals did not provide medication and most of them were not willing to attend to victims of political violence.

Several women’s organizations have assisted by housing women in safe boarding facilities. They appealed to different stakeholders to provide food, clothes and money. These organizations were also responsible for taking women who had sought refuge at Harvest House. In addition, they liaised with UN agencies to help fundraise and provide shelter for female victims of political violence.

JUSTICE

During the pre-run off election period, youth militia sanctioned by the ruling party temporarily replaced law and order enforcement agencies. Effective justice ensures due process, engenders a sense of fairness, and forms a basis for public law and order. The breakdown of these can be a major source of conflict. The attainment of justice and reconciliation only exists in a situation where rule of law prevails, all of which are absent in Zimbabwe. Women and girls have been victims of war crimes in “… all major African conflicts from Liberia, Sierra Leone, Democratic Republic of the Congo (DRC), Rwanda, Burundi, Northern Uganda, and Southern Sudan to Somalia” (Koen, 2006: 2). As Koen notes, justice systems and structures are usually among the first institutions to collapse in war and conflict situations. Thus, while conflict is raging, members of conflict-ridden societies do not have access and recourse to legal systems for crimes committed against them.

Most if not all rape survivors who reported their cases had no recourse to justice in Zimbabwe. The police were under instruction not to attend to any case. Furthermore, the majority of women who were raped only managed to get medical treatment more than a week after they had been raped. One woman mentioned that the police had indicated that “only assault could be reported and not rape. Reporting cases of rape means going against the government.” [13] With no police report, it was difficult to get assistance from the hospitals as they would require a document from the police.

INSTITUTIONAL CHALLENGES

The police are expected to be apolitical and impartial at all times. However, the Police Force has been brought into disrepute as it serves the interest of the government and not of the people. The Commissioner- General of the Zimbabwe Republic Police went public about his political affiliation to ZANU PF. He was further linked to the Joint Operation Command (JOC), the group that spear headed the militia attacks. Such actions exposed the police department to institutional breakdown and they were not in a position to assist people. Some police officers confessed that they themselves belonged to the opposition party and their hands were tied since the police high command operates on behalf of ZANU PF and hence they could not open dockets for cases of political violence.

CONCLUSIONS

The 2008 election period was characterized by systematic torture of voters inclined towards the MDC. The period between March 30 and June 27 2008 marks a watershed in Zimbabwe’s post-independence history. A time when the government turned against its citizens, instituting systematic torture reminiscent of Gukurahundi [15], sanctioning abuse designed to coerce people into voting for ZANU PF. In particular, women have been victimised as a means of political suppression and securing state control, suffering the additional abuse of physical violence and rape. The reasons for such abuse range from being spouses of MDC activists to not coming to ZANU PF rallies or coming late to such gatherings. The psychological effects have been compounded by the fact that systems of redress have broken down.

Violence against women is a form of discrimination and a violation of human rights. It causes untold misery, cutting short lives and leaving countless women living in pain and fear. It harms families across the generations, impoverishing communities and reinforcing other forms of violence throughout societies. Violence against women stops them from fulfilling their potential, restricts economic growth and undermines development.


* States in Transition Observatory. IDASA - An African Democracy Institute

* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/


BIBLIOGRAPHY

K. Chitsike The Nairobi Declaration, Research and Advocacy Unit, Zimbabwe, Harare, August 2008.

Karin Koen Occasional Paper 121- Claiming space reconfiguring women’s roles in post-conflict situations, February 2006.

Richard Smith, Fear, Terror and the spoils of power youth militias in Zimbabwe. Centre for the Study of Violence and Reconciliation.

Zimbabwe Peace Project report, March 29 Harmonized Election Post Mortem, An analysis of Trends, patterns and predictions for Electoral Run-Off., July 2008.

Centre for Human Rights, Gender- based violence in Africa, Perspective from the continent , University Of Pretoria Centre for Human Rights

http://www.amnesty.org/en/library/asset/AFR54/076/2004/en.html

http://pmep.cce.cornell.edu/profiles/extoxnet/metiram-propoxur/paraquat-ext.html

http://www.thezimbabwetimes.com/?p=424

INTERVIEWS

Interview with Beatrice Mtetwa, 28 August 2008

Interview with the Coordinator of Women’s Coalition, 6 Sept. 2008

Interview with a rape survivors, 9 September 2008



[1] The Zimbabwe African National Union – Patriotic Front (ZANU-PF) is led by Robert Mugabe, first as Prime Minister with the party simply known as ZANU, and then as President from 1988 after taking over ZAPU and renaming the party ZANU-PF.

[2] The Movement for Democratic Change (MDC) was founded in 1999 in opposition to ZANU-PF. The MDC was formed from a broad coalition of civic society groups and individuals that campaigned for a "No" vote in the 2000 constitutional referendum, in particular the Zimbabwe Congress of Trade Unions.

[3] Most of these persons were only willing to be interviewed on the condition that they remain anonymous.

[4] Personal Interview with Beatrice Mtetwa, 28 August 2008

[5] Interview with Beatrice Mtetwa, 28 August 2008

[6] Paraquat is a quartenary nitrogen herbicide widely used for broadleaf weed control. It is a quick acting, non-selective compound, that destroys green plant tissue on contact and by translocation within the plant. . Paraquat is highly toxic to animals by all routes of exposure, and is labeled with a DANGER-POISON signal word. A single large dose, administered orally or by injection to animals, can cause excitability and lung congestion, which in some cases leads to convulsions, incoordination, and death by respiratory failure. Paraquat is exceedingly toxic to humans. http://pmep.cce.cornell.edu/profiles/extoxnet/metiram-propoxur/paraquat-ext.html

[7] Interview with the Coordinator of Women’s Coalition, 6 Sept. 2008

[8] http://www.thezimbabwetimes.com/?p=424

[9] The stigma attached to women who have been raped has far-reaching social and economic consequences for the victims. Married women can be "disowned" by their husbands, although this is not always the case. As for unmarried survivors of rape, they may never be able to marry because they are stigmatized or considered to be "spoiled" by their communities. Sudan: Darfur: rape as a weapon of war: Sexual violence and its consequences.http://www.amnesty.org/en/library/asset/AFR54/076/2004/en/dom-AFR540762004en.html

[10] Interview with the Coordinator of Women’s Coalition, 6 Sept. 2008

[11] PEP reduces the likelihood of HIV infection after potential exposure. It is only effective if provided within 72 hours of the exposure, which poses a significant challenge in conflict situations.

[12] ibid.

[13] Personal interview with a rape survivor, 9 September 2008.

[14] Gukurahundi is a traditional Shona word which means ‘the early rain that washes away the chaff before the spring rains.’ It is the word chosen by the Mugabe regime to describe a military operation against a civilian population during the 1980s. In 1980, a few months after independence day, Robert Mugabe signed an agreement with the North Korean President Kim II Sung to have the North Korean military train a brigade for the Zimbabwean army. The objective of the 5th brigade was to crush the people of Matebeleland, force them to submit to Mugabe’s ZANU PF and relinquish their loyalty to Joshua Nkomo’s Zimbabwe African people’s Union (ZAPU)

[15] Study of the Secretary- General of the United Nations ‘Ending violence against women: from words to action’ 9 October 2006

Confronting three pandemics

Sonke Gender Justice Network

Bafana Khumalo

2008-12-02

http://pambazuka.org/en/category/comment/52364

In Sub-Saharan Africa we are confronted by three pandemics, poverty, HIV/AIDS and gender-based violence. Just over a year ago, we met as colleagues and discussed what is it that we can do to make a difference and re-shape the sketch of gender-based violence in our society.

We conducted a survey with over a thousand men around Johannesburg in the Gauteng province of South Africa, asking them three basic questions. First, What is men’s response to gender-based violence? Second, what is the government response and how do they feel about that response? And third, how would they intervene in reducing the scourge?

The responses were varied, but very interesting in many respects. On the first question, most men reacted with anger. They acknowledged that gender-based violence is indeed a major problem in our society, that they did not support it, and that it is something that needs to be uprooted from the roots so that all of the people in our society can have lives free of gender-based violence.

But what was very interesting for us was the response to the second question. Most of the men polled for this survey responded that government was doing too much! Of course, because in South Africa we have a legislative framework that seeks to respond to these gender challenges with our Domestic Violence Act, the new Sexual Offenses Act, the Maintenance Act and the myriad of other laws that are progressive, it does seem like Government is doing a lot-- at least at face value. So men do feel that government is doing too much because they often hear or read in the newspapers about men that face prosecution for these acts.

But the third response raised even more fundamental questions around involving men in the whole notion of gender equality. The men responded, ‘yes, we are keen to intervene, but often do not know what to do.’ ‘We are at loss. If I know that my friend is abusing his partner or spouse, what is it that I can do? More often than not if I do get involved, I become part of the problem because I then get accused that I have a relationship with his partner and that is why I am intervening."

This gave rise to what we developed as the One Man Can Campaign, which is a campaign that seeks to involve men because, indeed, from this survey it was clear that men do want to change. Men do want to engage in positive interventions that will reduce the scourge of violence in our society, but they lack skills of how to do it.

If you have grown up in an environment where virtually everything in society has told you it is correct to do certain things in a particular way, it is not easy to take a different view. The social script in our society communicates a message that asserts that violence is normal. Conflict is resolved through violence. This is part of the legacy of apartheid.

And so we developed this intervention as a way of mobilizing men so that, indeed, young men and boys and older men can play a positive role in reducing the scourge of Gender based violence in our society. This approach seeks to offer various options that men can take to play a meaningful and useful role in society that affirms the value of gender equality.

We targeted influential role players in society. In this process we work with traditional leaders because in many instances, when you talk to men about why they behave in these destructive ways towards women, and other men, part of the excuse people give is about culture. They argue that it is my culture that compels me to do this. And I always argue back that I am not an anthropologist, but the little bit of research that I have done on most cultures in our continent that I am aware of, asserts an opposite view. Most African cultures place a major responsibility on men to be providers and protectors of their families and loved ones. In fact a man who abuses his partner or any member of his family is frowned upon by society. In many instances there would even be communal censure for a man who behaves different to this expectation.

There can be no justification whatsoever for the kind of treatment that women get in our society on the basis of culture. On the contrary, what I have found is that cultures actually place a lot of burden on men to protect and provide for their families. That raises its own problems, but the point I am making is how culture is often misused in order to justify something that should not be justified even within this logic.

We work with religious leaders in our society because, once more, religion also plays a very influential role in ensuring that the status quo obtains. In most of our religious formations, very little positive intervention is given to the situation of gender-based violence. It is either condoned subtly or given a mystical definition like it is the devil that is making men behave this way, let us pray about it and hope it will go away. We all know though that this sort of intervention is not helpful. Violence continues in some instances to the point of death.

South Africa is regarded as a religious country. The majority of our citizens profess to follow some form of religious formation with the main one being Christian. The majority of leaders in these institutions are men. Possibly, they themselves do these things in their own homes and they will find nothing wrong with this kind of behaviour. Thus the response may be lukewarm.

We work with boys on gender awareness and health wellness because we also think this is very important. Most men thrive on what I call dangerous masculinities, masculinities that expose us men to all sorts of vulnerabilities. Having more girlfriends is seen as being very hip and chic and therefore, in order to prove your manhood, men are tempted to have as many sexual encounters as they can, with all the attended vulnerabilities that are related to this kind of behaviour.

But yet, as I said, men indeed do want to change and I want to give two quick examples. We work with an organization; I am glad my colleagues are here from Hoedspruit in South Africa. When we started work there just over a year ago, it was a very difficult terrain for us to go and work in, a farming community. We work with farm labourers who come from rural settings of our country; they are very conservative. Many from these areas would argue that culture is rigid and certain things have to be done in particular ways.

And we decided to start our work in that area with the farm Supervisors who are very influential in the farming area; they have the right to say who gets a job and the power to allocate accommodation in the compounds. And so there were lots of issues related to transactional sex, sexual abuse, abuse of alcohol and the related abuses that go with this kind of behaviour.

In doing this work with a group of Supervisors, we had as one participant an old man over 60, Every morning when we start our sessions, we start with a reflection of what we did the previous day. And as we learned from Paulo Freire, when you work with adults it is always important to get them involved in their own learning process so that they take responsibility for their learning and transformation.

And so on a Wednesday morning—we had started on a Monday-this old man raised his hand and said, “Now, I want to share something with you.” And I said to myself, Uh-oh, now we are going to have trouble. Because I expected, he was one of the most conservative in the group. He is probably going to tell us to pack up and leave. But he said the following: “I went home yesterday, Tuesday evening. I called all my children and my wife and I laid down the law. I told them from today, we are not going to wait for their mother to come back from work, because she knocks off later than all of us, to prepare dinner for us, to clean the house and do the washing.” He said, “I told my sons [he only has sons] that from today, things are going to change in this house. All of us are going to pitch in. We are all going to help with whatever we can.”

But he said, “Do not expect me to cook. I am too old to learn, but I will wash the dishes.” And that was a very significant transformation for me, that this man has come to this level and has not only ingested these ideas, but has begun to enact them in his own life. This approach by the old man raises its own challenges with regards to democracy, but I suppose we have to take it one step at a time!

The second example is one of a Traditional Leader in Kwazulu-Natal--a very progressive traditional leader. The issue related to the land of his community, which was taken away by the Apartheid government. To make the story short, he got married to one lady who was development-oriented person and who worked very hard to help the community reclaim their land after the advent of democracy in 1994.

They reclaimed the land and were successful. She started projects in the community and the community was involved food gardening and all sorts of very creative things utilizing their land and putting it to good and profitable use. When things were much more stable, the community approached the chief and said, “Well this wife you married, you married yourself. She is not the one we chose for you as the community. So, we are going to choose one for you as it is custom, so that you marry the one who will give birth to the next king for this tribe.”

And to his credit he refused. He said, “I cannot do that. How can I turn back on a woman who has been with me even when I was going through very difficult and trying times? How do I then now play this big chief who gets so many wives simply because the community says that is the way culture dictates that it has to be done.” And they engaged in serious confrontations, almost threatening to dethrone him. He approached the Gender Commission (a statutory body in South Africa) to lay a complaint. Now, this was a very interesting development since it is widely known in South Africa that the Kwazulu-Natal region is one of the most conservative areas, especially on cultural and traditional matters. To have a chief take that stand against his community, and to not stop there but to approach a constitutional institution to lay a claim against his own community—this is a positive sign that indeed men can change.

We have a lot of work to do. We must build on the positive notions that we see from men who seek to change and who are prepared to be agents for gender equality. We must build on the prospects of positive partnerships between men and women for equality.

* Bafana Khumalo gave this presentation at the International Aids Conference, Mexico City, August 2008, on behalf of Sonke Gender Justice Network
* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/

The "One Man Can Campaign"

Dean Peacock

2008-12-02

http://pambazuka.org/en/category/comment/52375

In South Africa, as throughout the world, gender inequality continues to undermine democracy, impede development and compromise people's lives in dramatic ways. Just twelve years into its hard won democracy South Africa is faced with twin epidemics of HIV/AIDS and violence against women—each propelled in significant ways by prevailing gender norms that encourage men to equate manhood with dominance over women, sexual conquest, alcohol consumption and risk taking.
South Africa has amongst the highest levels of domestic violence and rape of any country in the world. Research conducted by the Medical Research Council in 2004 shows that every six hours, a woman is killed by her intimate partner. This is the highest rate recorded anywhere in the world [i]. Inadequate recording of statistics makes it impossible to determine conviction rates for domestic violence but a recent study of domestic violence homicides in South Africa showed conviction rates no higher than 37.3% [ii] This violence and the unequal power it reflects between men and women is one of the root causes of the rapid spread of HIV in South Africa. Almost one third of sexually experienced women (31%) reported that they did not want to have their first sexual encounter and that they were coerced into sex. As a result, young women in South Africa are much more likely to be infected than men and make up 77% of the 10% of South African youth between the ages of 15 and 24 who are infected with HIV/AIDS [iii].

Men’s violence against women does not occur because men lose their temper or because they have no impulse control. Men who use violence do so because they equate manhood with aggression, dominance over women and with sexual conquest. Often they are afraid that they will be viewed as less than a “real” man if they apologise, compromise or share power. So instead of finding ways to resolve conflict, they resort to violence. We have used the term “men’s violence against women” because it is men who commit the majority of all acts of domestic and sexual violence.

However, research shows that South African men are not monolithic but instead hold a wide range of opinions about violence against women. A number of studies have been conducted to determine men’s attitudes and practices related to sexual violence [iv]. For instance, a recent survey of 435 men in a Cape Town township revealed that “More than one in five men …reported that they had either threatened to use force or used force to gain sexual access to a woman in their lifetime” [v].

A 2006 Medical Research Council survey of 1370 male volunteers recruited from 70 rural South African villages indicated that “16.3% had raped a non-partner, or participated in a form of gang rape; 8.4% had been sexually violent towards an intimate partner; and 79.1% had done neither” [vi]. In addition, a 2006 Sonke Gender Justice survey of 1000 men in the greater Johannesburg area suggested that about equal numbers of men support and oppose government efforts to promote gender equality with 41.4% of men surveyed saying that the government is doing too much to end violence against women and 38.4% of men surveyed saying that government is not doing enough to end violence against women. At the same time, 50.1% of all men surveyed felt that they should be doing more to end violence against women [vii]. This research shows that some men hold deeply alarming attitudes towards women, sex and gender equality. However, it also shows that a growing number of men and boys are strongly opposed to this violence and feel that it has no place in a new democratic South Africa.

While South Africa has alarming levels of gender based violence, it is by no means unique. The recent WHO Multi-Country Study on Women's Health and Domestic Violence indicates that domestic violence is a grave problem the world over and represents a fundamental violation of women’s rights [viii]. Faced with this reality, efforts have been made to involve men in ending gender based violence and in achieving gender equality. A number of international commitments have been made encouraging member states and signatories to implement strategies for engaging men and boys. International commitments to involving men and boys in achieving gender equality:

A review of international legislation and UN declarations presented at the fifty-first session of the Commission on the Status of Women in 2007 reports that “Equality between women and men is a fundamental principle of international law established in the United Nations Charter” and cites the following commitments:

* The 1994 International Conference on Population and Development affirms the need to “promote gender equality in all spheres of life, including family and community life, and to encourage and enable men to take responsibility for their sexual and reproductive behavior and their social and family roles.”[ix]

* The Beijing Platform for Action (1995) restated the principle of shared responsibility; and argued that women’s concerns could only be addressed “in partnership with men”.[x]

* At the 48th session, the UN Commission on the Status of Women called on Governments, entities of the United Nations system and other stakeholders to:

* encourage men to participate in preventing and treating HIV/AIDS;
* support men and boys to prevent gender-based violence;
*implement programmes in schools to accelerate socio-cultural change towards gender equality.

EVIDENCE BASE FOR INVOLVING MEN AND BOYS IN ACHIEVING GENDER EQUALITY

As new programs engaging men and boys have been implemented, a body of effective evidence-based programming has emerged and confirmed that men and boys are willing to change their attitudes and practices and, sometimes, to take a stand for greater gender equality.

The Medical Research Council’s evaluation of the Stepping Stones initiative implemented in the Eastern Cape showed significant changes in men’s attitudes and practices. With two years follow up, men who participated in the intervention reported fewer partners, higher condom use, less transactional sex, less substance abuse and less perpetration of intimate partner violence. [xi,xii]

In Brazil, Instituto Promundo’s intervention with young men on promoting healthy relationships and HIV/STI prevention, showed significant shifts in gender norms at six months and twelve months. Young men with more equitable norms were between four and eight times less likely to report STI symptoms with additional improvements at 12 months post intervention. [xiii]

Following upon these findings, the World Health Organisation recently released a report endorsing the efficacy of working with men to achieve gender equality [xiv].

Aware of these findings and as a signatory to many international commitments on involving men and boys in achieving gender equality, South Africa has made significant efforts to engage men and boys. The South Africa country report submitted to the 51st session of the UN CSW (http://www.genderjustice.org.za/sa-country-report-2007.html) chronicles the efforts of many government and civil society organisations.

One such initiative described is the One Man Can Campaign developed and coordinated by Sonke Gender Justice.

SONKE GENDER JUSTICE NETWORK AND THE ONE MAN CAN CAMPAIGN

The South African NGO Sonke Gender Justice (Sonke), works within a human rights framework to promote gender equality and reduce the spread and impact of HIV and AIDS.

To increase men’s commitment to gender equality, Sonke Gender Justice is currently implementing its One Man Can (OMC) Campaign in all of the country’s nine provinces and a number of 8 Southern African countries.

The purpose of the OMCC is twofold: to challenge the attitudes and behaviours held by men that compromise their own health and safety as well as the health and safety of women and children; and to encourage men to become actively involved in responding to gender based violence and the HIV/AIDS epidemic.

Sonke Gender Justice currently implements OMCC workshops with various groups of men in communities across South Africa and has provided training on the OMCC to a broad range of key stakeholders including government departments at the national and provincial levels as well as to traditional healers, faith based leaders, the police, youth serving organizations, in and out of school youth, teachers and other CBOs and NGOs.


DEVELOPING THE ONE MAN CAN CAMPAIGN

The One Man Can Campaign supports men and boys to take action to end domestic and sexual violence, to reduce the spread and impact of HIV/AIDS, and to promote healthy, equitable relationships that men and women can enjoy—passionately, respectfully, and fully.

The campaign was created to promote the idea that all men have a role to play, that “each one of us can create a better, more equitable and more just world. Formative research supporting the OMC Campaign

Sonke’s research showed that many men and boys are concerned about widespread domestic and sexual violence and want it to stop. Sonke heard that men and boys do worry about the safety of women and girls—their partners, sisters, mothers, girlfriends, wives, coworkers, neighbors, classmates, and fellow congregants—and want to play a role in creating a safer and more just world.

To decide on the content of the various “action sheets”, containing suggestions for action men and boys can take, a youth research team conducted a survey with 945 men in Johannesburg to get their views on what role they see for themselves and the government. Additionally, a formative research team conducted literature reviews to identify similar approaches used elsewhere and then ran many focus group discussions with survivors of violence, faith based leaders, teachers, coaches and young and adult men.

The project team also carried out a number of street surveys, stopping men in shopping malls, restaurants, barber shops and bus stations to find out how they understood the problem of men’s violence against women and what they would be willing to do about it.

For the campaign Sonke developed a kit to provide men with resources to act on their concerns about domestic and sexual violence. This includes materials such as stickers, clothing, posters, music, video clips, and fact sheets. In addition, the One Man Can Action Kit provides specific information and strategies on how men can: support a survivor, use the law to demand justice, educate children early and often, challenge other men to take action, make schools safer for girls and boys, and raise awareness in churches, mosques or synagogues.

IMPLEMENTATION TO DATE
Following its launch at the end of 2006, Sonke Gender Justice has started to successfully implement the OMC Campaign and use the Action Toolkit in various parts of the country.

In the Western Cape, Sonke has utilised the action kits with men in Khayelitsha and Nyanga Districts – including coaches, religious leaders, fathers, teachers, taverners, ward councillors and young people. The CDs have been introduced into jukeboxes in Cape Town taverns and shebeens and are being played extensively. The kits and workshop activities have also been used with hundreds of inmates and correctional staff in prisons across the province.

In rural areas in the provinces of KwaZulu-Natal and the Eastern Cape Sonke is using the materials to develop the capacity of men to be more involved in meeting the needs of children made vulnerable by HIV and AIDS. Specifically, the kits are being used to provide guidance to fathers and social fathers on what they can do to support orphans and vulnerable children. The materials are also used by teachers to carry out HIV/AIDS and gender based violence related activities with learners. In addition, the action kits also form the foundation for boys groups being run in schools that focus on the role boys can play in supporting orphans and vulnerable children.

In Limpopo Province, the campaign and materials have been adapted for use with commercial farm workers. In Gauteng, Sonke staff are using the materials in our work with refugees and migrants in Johannesburg’s inner city areas of Yeoville, Berea and Hillbrow where a team of 25 peer educators engage men and women on issues related to condom use, reduction of multiple sexual partners, HIV testing and ending gender based violence.

Most recently, Sonke partnered with Constella Futures and the National Department of Health to host a One Man Can national imbizo with 300 men from all nine provinces to explore their sexual and reproductive health experiences and needs. This meeting was followed by a technical consultation to develop national policies on men’s health and gender equality including on sexual and reproductive health.

Sonke has also used murals extensively to get the word out about the One Man Can Campaign. As an organisation, we are convinced that arts-based approaches can break through the monotony of many conventional educational and communications strategies.

The murals provide vibrant, colourful, community-designed messages about gender, HIV/AIDS and human rights in communities across the country – one in Gauteng with Khulani Primary in Soweto, three in the Free State, in four Western Cape prisons, at two schools and a community centre in Khayelitsha, and another four in Hoedspruit, Limpopo, done with farmworkers and with staff from Hoedspruit Training Trust. Leo Mbobo, a peer educator with PPASA who participated in painting a One Man Can mural across from a shebeen in Khayelitsha’s Town Two, had this to say about the impact of the mural: “The mural is stimulating debate in the community about gender-based violence and the role that communities can play in ending it. It is good that the message will be there in the community for a very long time to come.”

South Africans have a rich tradition of working for social change and social justice. We’re pleased that the OMC campaign seems to resonate with that history.

* Dean Peacock is Sonke Gender Justice Co-Director
* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/


For more information on the One Man Can Campaign, visit www.genderjustice.org.za/onemancan or email info@genderjustice.org.za

i Mathews, S. Abrahams, N. Martin, L. Vetten, L. van der Merwe, L. & Jewkes, R. (2004). “Every six hours a woman is killed by her intimate partner”: A National Study of Female Homicide in South Africa. Gender and Health Research Group, Medical Research Council, Tygerberg, 7505.
ii Ibid.
iii Pettifor A, Rees H, Stevens A (2004) HIV & Sexual Behaviour Among Young South Africans: A National Survey of 15-24 Year Olds, University of the Witwatersrand.
iv See the One Man Can fact sheet for more data on masculinities, violence, HIV AND AIDS and health at http://www.genderjustice.org.za/onemancan/images/publications/factsheet/factsheet_eng_lowres.pdf
v S. C. Kalichman, L. C. Simbayi, D. Cain, C. Cherry, N. Henda, A. Cloete (2007) Sexual assault, sexual risks and gender attitudes in a community sample of South African men; AIDS Care, Jan. 2007, Vol. 19,1, pages 20 – 27.
vi Rachel Jewkes, Kristin Dunkle, Mary P. Koss, Jonathan B. Levin, Mzikazi Nduna, Nwabisa Jama, Yandisa Sikweyiya; Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors; Social Science & Medicine 63 (2006) 2949–2961
vii Donald Ambe and Dean Peacock, (2006). “Understanding men’s perceptions of their own and government’s response to violence against women. Findings from a survey of 945 men in the greater Johannesburg area. Sonke Gender Justice Network; December 11, 2006 and PlusNews Special: “Closing the gap: Gender-Based Violence in South Africa: Men slowly turning away from gender-based violence”. Downloaded from http://www.plusnews.org/webspecials/PNGBV/6643.asp on February 21, 2007.
viii WHO multi-country study on women’s health and domestic violence against women: summary report of initial results on prevalence, health outcomes and women’s responses. Geneva, World Health Organization, 2005.
ix See paragraphs 4.11, 4.24, 4.25, 4.26, 4.27, 4.28, 4.29, 5.4, 7.8, 7.37, 7.41, 8.22, 11.16, 12.10, 12.13 and 12.14 of the Cairo Programme of Action, and paragraphs 47, 50, 52, and 62 of the outcome of the twenty-first special session of the General Assembly on Population and Development.
x See paragraphs 1, 3, 40, 72, 83b, 107c, 108e, 120 and 179 of the Beijing Platform for Action.
xi Jewkes R, Wood K, Duvvury N. ‘I woke up after I joined Stepping Stones’: meanings of a HIV behavioural intervention in rural South African young people’s lives. Social Science & Medicine (submitted)
xii Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Koss M, Puren A, Duvvury N. Impact of Stepping Stones on HIV, HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. British Medical Journal (submitted)
xiii Pulerwitz J, Barker G, Segundo M (2004). “Promoting Healthy Relationships and HIV/STI Prevention for Young Men: Positive Findings from an Intervention Study in Brazil. Horizons Research Update”. Washington, DC: Population Council.
xiv World Health Organization (2007). Engaging men and boys in changing gender-based inequity in health: Evidence from programme interventions. Geneva

Who's normal? Disability, discrimination, and HIV/AIDS

Winstone Zulu

2008-12-02

http://pambazuka.org/en/category/comment/52372

I have been asked whether I could put down my thoughts on a couple of pages on what living with a disability is like and the challenges that I have experienced as a result. I am glad to share these experiences and my personal thoughts with readers of Pambazuka News. I have also taken the liberty of expanding my discussion to include other forms of discrimination that I have faced because of being different from what is considered ‘normal’.

Unfortunately, I will not attempt to answer the difficult question of why some people react with such revulsion at the sight of a person with a certain disability. I still do not understand why whole societies stigmatise and discriminate against persons with disabilities when compassion and understanding is what is most needed. I have often wondered whether my presence brings to the fore the reality that everyone is vulnerable to disability, either through illness or accident. Or that, in fact, even a very long and healthy life can eventually lead to disability. Maybe the idea behind shutting doors to persons with a disability is no more than an attempt to ‘see no evil, hear no evil, speak no evil’. Could it be that my presence is perceived as a bad omen that speeds up someone else’s process of becoming disabled?

Fortunately, I have faced stigma and discrimination for other reasons that make me doubt the reasoning above. If it were true that my presence reminds someone of their everyday likelihood of getting disabled, why would a white man discriminate against me? How would my presence make him susceptible to becoming black? I don’t know, and maybe it’s just me, but I can’t seem to tell the difference between the colour and general physical features of Germany’s Chancellor Angela Merkel and Melanie Vant, a young Jewish friend of mine in Washington, D.C. Honestly, I cannot tell much difference between those Saudi Arabian kings and George W. Bush or John McCain. But I believe that when there is a deliberate intention to discriminate, differences are created. It is said somewhere that those that are targeted for discrimination are the first to be stigmatised. And so we had Hutus in Rwanda coming up with a ‘clear’ description of how Tutsis looked despite generations of intermarriages and intermingling.

These days I hope to get a better insight into these hard questions in the course on disability and development that I have been invited to attend at Ryerson University in Toronto, Canada. At the moment I have a feeling that it is not what we look like or what kind of disability we have that makes us targets for stigmatisation and discrimination. There could be deeper reasons. When I get to the bottom of that I will send you an update. Meanwhile, here are my experiences and thoughts around this topic.

I had polio when I was three years old. My mum tells me that my entire body was paralysed at one stage. Mercifully, most of my limbs and body functions retained full control except my right leg where the muscles failed to fully develop. As a result I ended up walking with a very bad limp throughout my childhood and part of my adult life. When I turned 38 my body could no longer support the weight that often accompanies entry into middle age. I started using crutches, which I still do. For longer distances such as at airports and university campus I use a wheelchair.

In Zambia, where I was born, my first experience of discrimination based on disability was when my mum tried to enrol me into first grade when I turned seven. One look at the way I was standing was enough for the head teacher to conclude that giving me a place in school would be a waste of government resources. This was despite the fact that I could prove that I could read and write. My immediate elder sister, Monica, had taught me the basics at home and I had picked up enough on my own to fit in the first grade. The following year, mum took me to another school but entry was denied for the same reason. After a third attempt she gave up as the argument had now even changed from that based on my disability to that of being over-aged for grade one. It was not until I was 14, when my eldest sister Matilda managed to find me a place in the fourth grade, that I first set my crippled foot in a classroom. Because of this delay I was only able to complete my secondary school when I was 23 – with all the complications of mixing with sixteen-year old kids and teachers who were around my own age.

Despite these challenges, when I was 26 I managed to get a scholarship to study political science in St Petersburg – then Leningrad – Russia. One of the requirements for entry into Russia was a full medical examination which included an HIV test. My HIV test results were positive and access to enter Russia denied. It was around this time that I first started to connect the dots between the stigma and discrimination that surrounds disability and other conditions such as HIV/AIDS. For example, when I asked why I could not travel and study in Russia, the answer was not that I would be a danger to other people in that country. The refusal to allow entry was based on the premise that I could get ill there and be a burden on the Russian government’s medical resources. Memories from twenty years ago flooded my mind and I could see that small boy in khaki shorts and blue golf shirt standing in a queue, full of hope and expectation, anxiously waiting to be enrolled into first grade, only to be told that it would be a waste of government resources to give a disabled child a place in school.

In 1992 I was invited to assist in setting up an AIDS program at the Valley Trust, right in the middle of the beautiful Valley of a Thousand Hills in Kwa-Zulu Natal, South Africa. I was offered a year’s contract but my accommodation would not to be ready for a couple of months. In the meantime, a young couple that I met during one of my talking circuits invited me to stay with them. The director of the Valley Trust, a Mr Pit, would then pick me up at a gas station nearby and drive with me to the project site, about five kilometres away. Every morning of each working day I stood by the gas station waiting for Mr Pit to pick me up. And so did a white boy of around 17 years of age who was picked up by a white woman on their way to some workplace uptown in Botha’s Hill. Everyday, we stood side by side. Sometimes his pick-up would come earlier and some days mine would. After a while we started talking and chatting to each other and we would say bye-bye when either of us was picked up.

One morning a police car stopped by and one of the two officers asked us what we were waiting for. We each explained to him that we were waiting to be picked up. He ordered me from that day onwards to go and wait at the nearby bus stop but allowed the other boy to wait as usual at the gas station. When Mr Pit drove up I explained to him why I had moved further down the road. He said that was what apartheid was all about. Just being black meant I was a danger of perhaps blowing up the gas station, he told. Or, maybe, I was simply unsightly standing there in my black skin, I thought.

In 2003 I was invited to visit by both RESULTS-Canada in Ottawa and RESULTS-International based in Washington, D.C., USA. I applied for a Canadian visa back home in Lusaka, Zambia, but decided to apply for the US one from the American Embassy in Ottawa. On one of the forms there were a list of questions that inquired whether you had been convicted before, were involved in a war crimes tribunal, an expert in arms and bombs, etc. The very last question in this category was whether you had an infectious disease of some significant public health concern. Although I already knew that the US, like Russia, did not allow entry to HIV positive people, I answered yes to the last question. Besides, I was entering the US for a media promotional tour which would involve talking about my living with HIV; how could I not tell the truth?

I was asked to report the following day for the results of my application.

And there, in room full of white people, I sat in a wheelchair facing a white immigration officer who sat behind a glass partition. There was microphone to allow me communicate with her. But for some reason the technology was not working well and we ended up shouting in order to hear each other.

Her: ‘You answered yes to the last question on this form. What infection do you have?’

Me: ‘HIV.’ (I whispered, trying to mould the words around my lips as clearly as I could so she could understand without having me shout).

Her: ‘Pardon?’

Me: ‘HIV.’ (I screamed and looked behind me. All eyes were on me alright but I didn’t really care anymore. I just became sort of numb, like I was the only one in the room).

But she was not done yet. She excused herself and went into a back room for about a minute. When she came back our discussion went something like this:

Her: ‘I am sorry, Mr Zulu. According to US government policy persons with HIV are inadmissible to enter the United States of America. I cannot issue you a visa.’

Me: ‘Why?’

Her: ‘I don’t know but it’s the law. You are in the same category as terrorists and drug traffickers.’

Mind you this was barely a year after 9/11 and at the mention of the word terrorists, the whole room was all-ears listening to this exchange and I have yet to find a more zealous audience.

I later rang my contacts in Washington who got in touch with a number of members of Congress who in turn wrote letters of support to the embassy to issue a waiver to allow me enter those United States of America. That should have been fine but for the kind of stamp they put in my passport. It said I was paroled to stay in the US for about 60 days because I was going there to carry out activities of public significance.

Talk about multiple stigmas. I was black, visibly disabled and HIV positive. Added onto that, now my passport said I was ‘paroled’ – whatever the meaning intended, it still smelled of felony to my nose and looked it to those that saw it later. I recall that on the way back an immigration officer on the Canadian side showed my passport to his colleague and said, ‘look at what our friends in the south are now stamping in people’s passports.’

What do I make of all these experiences?

I believe my becoming visibly disabled at such a young age makes me look at things from a rather different perspective from many other people. A hundred times I have stumbled over nothing and heavily fallen, often in public. I once fell on the airport tarmac as I was walking to board a British Airways plane in Lusaka. Hundreds of people were bidding their relatives and friends farewell from the gallery above. So were my wife, children, and friends. Tens of times I have been invited for a radio, television show, workshop, or seminar and I find the venue is on the third floor and there is no elevator. Several times I have shared my story of living with HIV and when asked how I contracted and I reply that it was through sexual intercourse, jaws drop simply because I am sitting in a wheel chair. And this is often from the same group of persons who only moments before were suggesting that people who contract HIV are promiscuous. So, okay, here is a person with a disability who is ‘confined’ to a wheel chair and is supposed to be asexual but is HIV positive. That is not convenient for many audiences I have had discussions with. It kind of rips opens and exposes their neat but false theories and stereotypes about disability, sexuality, and AIDS.

When travelling I prefer to be on my own because when I am with someone else, airport personnel do not talk to me but the person that I am with. ‘How many pieces of luggage does he have?’ And at the coffee shop, ‘How many sugars does he take?’ Am I incapable of speaking for myself? Please have eye contact with me. Talk to me.

My expectations of society for people with disabilities are basic but fundamental. I cannot speak for all people with different forms of disabilities. But generally, I just want to be treated as any other human being. I want an environment that can provide me with full access to what everyone else has a right to. That means the full range of human rights including the right to be involved and actively participate in all issues that affect the human family. I don’t want to be ignored simply because I am using a wheel chair to move from point A to point B. I recently read a story from South Africa about AIDS community mobilisers who were inviting all members of their community to an HIV awareness meeting. But when they found a young disabled mother sitting in her wheelchair, they decided not to invite her as well! All persons with disabilities, regardless of the type, must be given the same opportunity to education and other social and economic rights as other citizens. Having cerebral palsy or Down’s Syndrome should not be an excuse to deny a person a chance to a full life.

What are the chances that these expectations can be fulfilled? I am an optimist. I have always been. I draw great lessons from history. There have been and are still many dark and unacceptable things that go on in our world today. It wasn’t such a long time ago that women in the USA and much of the Western world did not have a vote. In several Middle-East countries they cannot yet vote or stand for presidency or even drive a car. The Catholic church still will not ordain women priests. This is for no reason other than that they are women. In the USA, supposedly the most advanced and civilised nation on earth, every four years, including this one, leaders waste precious time and resources debating what two consenting adults can or cannot do in bed based purely on sexual orientation or preference. And for the same reason many Anglican denominations in Africa and indeed the world over are on the verge of splitting over the ordination of gay priests. This is at a time when there are critical issues of human rights abuses in places like Burma, Sudan, Zimbabwe, Congo and Tibet as well as the looming catastrophe of climate change caused by global warming that call for urgent and thoughtful leadership.

So the fight for disability rights has to compete against all these real issues as well as distractions such as whether life begins at conception or not. We will need to intensify our advocacy campaigns by becoming much more visible and vocal – both locally and globally. It’s not going to be easy. But such struggles have never been given on a silver platter. We have to fight with a purpose to achieve our goals. Eventually, we will succeed.

I know that in the end I am starting to sound rhetorical. And yes, at times I feel like this is a very lonely planet in the entire universe. That there is very little hope for change. But believe you me, change for good eventually comes. I believe that a little contribution from all over us can bring that change.

Before I close let me share with you all something else. I always travel with the crucifix even though my faith in God is smaller than a mustard seed. But the symbol of the crucified Christ shows to me someone who bore what I think was the ultimate stigma. They could have killed him in many other ways. They could have stoned him to death like they did Stephen. But death on the cross, particularly between two criminals, was a mark of disgrace, a shame. Although many people including famous celebrities use or wear the cross as fashion apparel, I see no glory in what went on at Golgotha. To me the cross is a reminder that we are in this world for one important purpose and that is to serve and help others, especially those in less privileged situations and positions than we are. Any other way I have tried to search for happiness and meaning has left me dissatisfied and yawning.

Regardless of how long it takes, good triumphs over evil.

Need evidence? Well, it wasn’t until the end of June this year, to the embarrassment of Condoleezza Rice, that the State Department of the United States of American struck Nelson Mandela off its list of terrorists. And oh yes, there was an American election on 4 November. Change for good will eventually come.

* Winstone Zulu is a visiting fellow at the School of Journalism, Ryerson University, Toronto, Ontario, Canada.
* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/

Equalise it: The visually impaired and HIV/AIDS programmes

Elly Macha

2008-12-02

http://pambazuka.org/en/category/comment/52369

‘I attended a training session in my home area but I did not enjoy it because they used a video which I didn’t understand because nobody explained what was going on; they also gave me a print booklet to read. But after I attended the training by Rahab, I understood much better because I touched a condom and learned how to use it. Things were explained to me much better.’

These are comments by Jean Pierre, an 18 year-old high school student in Rwanda. He was among the beneficiaries of the community training activities organised by the Rwanda Union of the Blind. This training was conducted by blind and partially sighted HIV/AIDS Peer Educators, Rahab being one of them.

‘I am a teacher and have had the opportunity to make presentations to several groups including a pan disability group. I continue to be approached with questions and have made several presentations to sighted groups within the community. This is continuing following one year from the original training in February 2006.’

These comments were made by John, a partially sighted HIV/AIDS Peer Educator from Kenya.

‘I think that visually impaired persons who are also living with HIV should be encouraged to form support groups of their own. This will create an ideal forum for other visually impaired persons out there to open up about their status. In the end it will be easy for us to penetrate mainstream support groups. There are many blind people out there who could be infected and do not even know it.’

This view was shared by a female participant during HIV/AIDS Peer Educator’s workshop for blind and partially sighted persons in Lesotho. This participant is also living positively with HIV and is a leader of the support group in her home area.

‘I once went to be tested for HIV at the clinic. The female counsellor I met there asked if I knew how to perform sex. I answered in amazement, would you like me to show you how it’s done?’

This was the experience of Jacque Mogisho, a young person from Rwanda. He was sharing his own experience of how negative attitudes and misconceptions from service providers make visually impaired persons shun these services altogether. This was during the training workshop for young visually impaired persons in Uganda.

‘I am now empowered, a different person. I now have useful knowledge to share with my community and sighted people are approaching me with questions. I feel my status in the community has risen and I am one of them even though I am blind, and my skin is a different colour (albino). This has given me confidence to go further in sharing information and joining groups. Prior to having training and playing an active role in the community, I was reserved and did not feel I had the ability to speak in front of people… Life is difficult. You have no idea how my self worth has grown. I am motivated to continue with training and work in my community to spread the news and use my new information to help others and maybe find a job in counselling!’

These comments were made by Monica, a female HIV/AIDS Peer Educator after participating in the Peer Educators’ training in Kenya.

These are some of the experiences from blind and partially sighted participants from different countries about how HIV/AIDS programmes can address their needs. There are so many programmes addressing HIV/AIDS prevention and control, yet many disabled people are deliberately left out in these interventions.

Recently, given this state of affairs disability and HIV/AIDS issues have been discussed widely. Disabled persons have begun to address HIV/AIDS issues among themselves. At African Union of the Blind (AFUB) we have endeavoured to address issues of blind and partially sighted persons in relation to HIV/AIDS. AFUB is a continental umbrella organisation of 54 associations of and for blind and partially sighted persons in Africa spread in 50 countries. In a period of three years (2006–2008) we have conducted HIV/AIDS Peer Education training workshops in ten countries by training members of national organisations of the visually impaired in those countries to become HIV/AIDS Peer Educators. The countries are: Cameroon – Assocition Nationale des Aveugles du Cameroun (ANAC); Ghana – Ghana Association of the Blind (GAB); Kenya – Kenya Union of the Blind (KUB); Malawi – Malawi Union of the Blind (MUB); Rwanda – Rwanda Union of the Blind (RUB); Tanzania – Tanzania League of the Blind (TLB); Lesotho – Lesotho National League of the Visually Impaired Persons (LNLVIP); South Africa – South Africa National Council for the Blind (SANCB); Ethiopia – Ethiopia National Association of the Blind (ENAB); and Zambia – Zambia National Federation of the Blind (ZANFOB).

The aim of these workshops is to empower visually impaired participants and equip them with HIV/AIDS Peer Education skills so that they can go to their home areas and impart the same knowledge of HIV/AIDS to other visually impaired persons. In addition to increasing their knowledge on HIV/AIDS, participants also discuss and prescribe ways on how HIV programmes and services can be made accessible for blind and partially sighted persons. One other way of sensitising mainstream service providers on how they can adapt their programs to make them accessible to blind and partially sighted persons is through involvement. During these Peer Educators’ workshops, facilitators and trainers from mainstream HIV organisations such as voluntary HIV counselling and testing (VCT) service providers and networks of people living positively with HIV were invited to conduct some training sessions.

During this whole process there are certain key lessons that we have learned:
- Involving mainstream AIDS service organisations and service providers in the training activities: The development of manuals and HIV resources makes it easier to communicate to them about the needs of blind and partially sighted persons are in as far as HIV/AIDS programmes and services are concerned.
- Continuous and systematic data collection and record keeping on the experiences of blind women and men regarding HIV/AIDS is important as it assists in implementing evidence-based HIV programmes.
- HIV/AIDS conferences and seminars have also offered ideal opportunities for presenting issues of blind persons as far as HIV/AIDS is concerned.
- Participating in the Africa Campaign on Disability and HIV/AIDS has helped to bring the voices of many blind women and men in the continent to the fore.
- To uphold greater involvement of people living with HIV/AIDS. Presenting samples of HIV resource materials in accessible formats to mainstream AIDS organisations plays a huge role in sensitising them about how they can adapt their programmes so as to make them accessible to blind persons.

See also the [http://www.pambazuka.org/images/articles/409/AFUBNEWS.pdf]AFUB Annual Report[/url].

* Elly Macha is with the African Union of the Blind.
* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/

Treatment Action Campaign and the South African state's response to HIV/AIDS

Rebecca Hodes

2008-12-02

http://pambazuka.org/en/category/comment/52376

In the last decade, barrels of ink have been spilled on the failure of the South African state to address the growing HIV/AIDS epidemic among its people. In the opening years of the century, President Mbeki and his Health Minister, Manto Tshabalala-Msimang, became the focus of widespread derision due to their alliances with AIDS denialists and their obstruction of effective treatments for HIV/AIDS. During these years, the Treatment Access Campaign (TAC), founded by a small group of activists in 1998, led and ultimately won the struggle for public access to antiretroviral treatment in South Africa.

TAC has gained global recognition for its successes in securing cheaper access to generic medications in the public sector, lobbying for the introduction of a public programme of prevention-of-mother-to-child-transmission therapy in 2001, and for its continued contribution to ensuring the success of South Africa’s national programme of comprehensive HIV treatment. The last decade of South Africa’s HIV/AIDS response has therefore often been portrayed as a battle between activists committed to the health and human rights of people with HIV, and a recalcitrant political leadership refusing to accept the challenges posed by the epidemic. However, changes in the political landscape, detailed below, have heralded a new era. The state’s guiding policy on HIV/AIDS, known as the National Strategic Plan for 2007 – 2011, is South Africa’s most progressive policy on the epidemic to date. And with a new Minister at the helm of the Health Department, South Africa’s roll-out of antiretroviral treatment is continuing apace, albeit not without problems.

In recent months, South Africa has undergone a number of seismic political changes. The controversial, populist Jacob Zuma, was elected the head of the ruling African National Congress (ANC) at the party’s national conference in December 2007. Zuma’s appointment was met with dismay by HIV/AIDS activists, as well as many other South Africans, owing in large part to a rape charge brought by an HIV-positive woman in late 2005. Zuma was acquitted, but some disturbing revelations emerged at the trial.

Maintaining that the sex was consensual, Zuma admitted that he was aware that the complainant was HIV-positive, but that he had nonetheless failed to wear a condom. He also explained that he had taken a shower after having unprotected sex with the woman, in order to protect himself from HIV transmission. As the former head of the National AIDS Council as well as the so-called ‘Moral Regeneration Campaign’, Zuma’s admission that he had had unprotected, extra-marital sex with a woman whose HIV-positive status he knew, encouraged widespread public confusion about the risk of HIV-transmission via unprotected sex. HIV activists and other leaders of civil society responded with fury and frustration to Zuma’s assertion that he had showered in order to reduce the chances of being infected with HIV, arguing that his foolish remarks would encourage confusion around HIV infection and reverse hard-won gains in public awareness around the epidemic.

Moreover, many of the comments made by Zuma and his supporters during the case were overlaid with misogyny. Zuma’s supporters, who gathered daily outside the court, threatened the complainant and even threw stones at another woman mistaken for her. Zuma himself conveyed a bigoted and oppressive attitude towards women in his suggestions that women who dress in a particular way or have a certain sexual history are inviting sexual advances.

The acquittal was greeted with dismay by women’s rights groups and other civil society leaders across South Africa. Meanwhile, Zuma’s political ambitions were temporarily frustrated, not so much by the rape charges as by corruption charges relating to South Africa's 1999 arms deal, and to his relationship with his previous financial advisor, who was imprisoned for fraud and corruption in July 2005. Zuma’s corruption case is pending, as a procedural point will soon be argued in the Supreme Court of Appeal. However, as the current President of the ANC, if Zuma is cleared or pardoned of corruption charges it is likely that he will be the next President of South Africa. There is much speculation about Zuma’s possible HIV policies should he become the next President. It is possible that Zuma’s dogged traditionalism will find expression in HIV policies. He may support ‘virginity testing’ of young women, and impose other culturalist proscriptions pertaining to sexual behaviour. It is also possible that Zuma may try to make amends for the damaging remarks made during his rape trial, and to distance himself from Mbeki’s discredited stance on HIV, by promoting more progressive policies on comprehensive HIV care and particularly ART as South Africa scales-up its public ART programmes.

In September 2008, President Mbeki was deposed by the ANC’s Zuma-dominated leadership. This was subsequent to allegations that Zuma’s prosecution was animated by Mbeki’s desire to sideline Zuma. Kgalema Motlanthe, an ANC stalwart with strong ties to the Unions, was made interim President pending next year’s elections - after which is its widely expected that Zuma will assume the presidency.

One of the side-effects of Mbeki’s ousting was a Cabinet re-shuffle. Some ministers resigned in solidarity with the ousted President. Among those who remained were the Health Minister Tshabalala-Msimang. Derisively labelled ‘Dr. Beetroot’ owing to her to long-standing insistence that healthy diets and traditional medicines were appropriate treatments for HIV, Tshabalala-Msimang was reassigned by President Motlanthe to the office of the Presidency. In her stead, Barbara Hogan was named the new Health Minister - a step that was met with rejoicing by the TAC and other leading civil society organisations.

Hogan has a long history with the ANC, and spent almost a decade in prison due to her anti-Apartheid activism. She became a member of parliament subsequent to South Africa’s first democratic election in 1994, and joined the Finance Portfolio Committee. She chaired the Portfolio for five years until President Mbeki removed her from the position, allegedly due to her explicit opposition to the President’s stance on HIV/AIDS. Hogan was one of the few members of parliament to openly oppose President Mbeki’s AIDS denialism and the failure of Health Minister Tshabalala-Msimang to support the public roll-out of ART. Hogan is known for her pursuit of financial transparency and accountability within political structures. These qualities will be of particular value in the Department of Health, renowned for its lack of financial accountability as reflected in the Department’s overspend of R450 million in the last fiscal year.2 The details of the overspend remain uncertain due to the lack of public accountability that previously characterized the Department’s functioning.

The lack of openness surrounding the Department of Health’s expenditure is largely attributable to Tshabalala-Msimang’s gross mismanagement of the Department. But perhaps even more serious than this lack of fiscal oversight are the structural weaknesses within the health sector, which were neglected by Tshabalala-Msimang during her disastrous nine year tenure.

The health care system in South Africa, as in much of the rest of the continent, is hobbled by a shortage of doctors and nurses. In 2006, the African Union estimated that low-income countries subsidized high-income countries to the tune of R500 million per year, through the loss of their healthcare workers.3 In 2007, the World Health Organisation estimated that Southern Africa accounted for 25% of the global disease burden, yet had only 2% of the world’s healthcare workers. The South African Medical Association, Médecins Sans Frontières (MSF) and the Democratic Nurses Organisation of South Africa (Denosa) have long pointed to the critical lack of healthcare workers in South Africa.

The skills shortages, quality disparities between urban and rural healthcare centres, and the ubiquitous lack of resources in the public health system are partly the legacy of Apartheid-era public health policies, which concentrated resources in the richest provinces and urban areas in particular.4 But the skills shortage was exacerbated by Tshabalala-Msimang’s failure to enact measures to ameliorate the crisis. This skills shortage was identified as far back as 2001 as the health sector’s ‘key constraint’.5 In 2003, the National Health Act called for the Minister to develop a strategic plan to address the flight of doctors, nurses and pharmacists to rich world countries, where salaries were higher and jobs less demanding. Between 1989 and 1997, 80 000 health workers emigrated, and by 2003 there were roughly 30 000 unfilled positions in the public health sector.6

By 2005, the health sector was facing a critical shortage of doctors and nurses, with staggering vacancy rates at hospitals and clinics.7 But despite promises by the Health Minister of a national human resources plan to address shortages in health personnel, the plan was delayed, leading the general secretary of the Denosa to remark that, ‘By the time they [the government] are willing to negotiate with us, there may not be any nurses left in the public sector’.8 Shortly after her assumption of the position as Minister of Health in September 2008, Hogan explained that her first priority was to boost the morale of healthcare workers, encouraging doctors and nurses to remain within the health sector to ameliorate the critical shortage in skills. In her landmark speech at the HIV Vaccine Research Conference in Cape Town on 13 October 2008, Hogan stated: ‘We know that HIV causes AIDS. The science of HIV and AIDS is one of one of the most researched subject in the medical field’.9 This statement garnered wide attention in the local and international press, because of the change it conveyed to years of prevarication by Mbeki and Tshabalala-Msimang over the causes of HIV and the optimal forms of treatment.

Over two million South Africans died of AIDS during the presidency of Thabo Mbeki. A study recently published by the School of Public Health at Harvard claims that 330,000 lives could have been saved had Mbeki and Tshabalala-Msimang implemented the necessary treatments for HIV, including ARVs and the prevention-of-mother-to-child-transmission programmes. Instead, Mbeki and his health minister engaged in AIDS denialism and undermined the scientific governance of medicine. Many more people would have died had it not been for TAC’s activism, which led to Constitutional Court orders compelling Mbeki and Tshabalala-Msimang to implement an HIV treatment plan which included the provision of PMTCT and ARV’s.

The redeployment and essential political declawing of Tshabalala-Msimang, and the institution of Minister Hogan were evidence of further shifts in the state’s policies on HIV/AIDS. Growing opposition to high-ranking political obstruction of antiretroviral treatment and the championing of traditional remedies and nutritional supplements came to the fore in mid-2007, when Deputy President Phumzile Mlambo-Ngcuka and Deputy Health Minister Nozizwe Madlala-Routledge spearheaded the development of the National Strategic Plan on HIV/AIDS and Sexually Transmitted Infections, 2007 – 2011. The plan drastically overhauled the state’s commitments to addressing HIV and other sexually transmitted diseases, and brought together civil society, healthcare workers and other interested parties. For the first time in years, government and activists mutually accepted new policy positions on HIV, and began to collaborate on the expansion of key health programmes concerning the education, prevention and treatment of HIV and other sexually transmitted infections.

While these shifts are welcome, celebrations may be premature. Minister Hogan’s position is only guaranteed until the election which is set to take place early next year. While the Zuma prosecution plays out in the courts, analysts can only speculate whether or not Hogan will remain in her post once, as expected, Zuma takes the reins following the election.

The ruling ANC has split, and a new party has emerged under the direction of previous ANC and Union leaders who are disaffected by Mbeki’s abrupt ousting and the prospects of being governed by Zuma. Named COPE (the Congress of the People), the very title of the party is disputed by the ANC, which claims ownership over the anti-Apartheid activities of the 1950s to which the name refers.

Hogan's biggest challenges will be to meet the treatment and prevention targets of the HIV/AIDS National Strategic Plan, integrate TB and HIV treatment, develop a feasible human resources plan for health workers and undo the considerable legacy of AIDS denialism left by her predecessor. TAC will do all that it can to assist her and the Department of Health to meet these challenges.

* Rebecca Hodes is Director of Policy, Communication and Research, Treatment Action Campaign (TAC). (Thanks to Nathan Geffen, whose previous research on HIV in South Africa forms the bedrock of this article. Thanks also to Adv. Michael Obsborne for his valuable comments.)

* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/

Dual epidemics in a young Democracy

TB/HIV in South Africa

Rebecca Hodes and Lesley Odendal

2008-12-02

http://pambazuka.org/en/category/comment/52366

For many years, South Africa’s HIV/AIDS epidemic has been the focus of international attention. The state’s obstruction of a public roll-out of antiretroviral therapy (ART), due to AIDS dissidence within the highest echelons of government, drew international attention to the politicization of HIV in South Africa. Moreover, high rates of HIV infection elicited questions regarding the sexual culture, socio-economic conditions and biomedical realities of the so-called ‘rainbow nation’.

But while the attention focused on HIV was duly warranted, another epidemic has remained largely ignored. This is despite its intimate connections with HIV morbidity and mortality, and the important questions beggared by the interactions between the two diseases. HIV is a relatively new disease in South Africa, with the first deaths of citizens from AIDS taking place in 1982. But Tuberculosis (TB) has a much longer history, reflective of the industrial and demographic processes which shaped South Africa’s past and which continue to impact on the health of the population at large.

Why South Africa?

With its history of inequitable distribution of resources and health facilities, South Africa has long shouldered a heavy disease burden of TB.[1] The migrant labour system, in which miners lived and worked in cramped, unsanitary conditions in between visits to their home communities across South Africa, provided fertile conditions for the emergence and entrenchment of a national TB epidemic.

The interaction of TB and HIV in South Africa requires far greater attention and research. Put broadly, however, the rapid spread of HIV across South Africa during the early 1990s is partly attributable to the high national prevalence of TB, and its weakening impacts on the general immunity of the population. The confluence of these diseases also works in the opposite direction, with the biomedical effects of HIV resulting in higher TB caseloads, and more virulent TB infections. Approximately 53% of South Africans with TB are also HIV-positive,[2] with dual infection rates of up to 80% in some communities.[3] HIV infection increases the risk of developing TB by tenfold.

The Double Bind

Due to the Treatment Action Campaign’s court case victory to compel the state to implement a national ART programme, from 2003 the Department of Health was required to initiate a programme of public access to ART. As of November 2008, approximately 350 000 South Africans were accessing the treatment in the public sector, and a further 100 00 in the private sector. Due to expanding access to ART, many South Africans are living healthily with HIV. However, due to high rates of TB/HIV co-infection, TB/HIV is currently the primary cause of death in South Africa.[4] Recorded TB deaths have increased from approximately 25 600 in 1997 to 77 000 in 2006, accounting for 12% of all natural deaths in South Africa.[5] This is despite the fact that TB is curable and largely preventable through infection control measures and access to prophylaxis for high-risk populations (including healthcare workers and people living with HIV). National incidence rates are escalating, and in 2006, the World Health Organisation (WHO) estimated that there were 940 cases of TB for every 100 000 people in South Africa. The WHO recently ranked South Africa fourth among the world’s 22 high-burden TB countries in terms of absolute case numbers.[6]

State of Emergency

In 2005, the former Minister of Health, Dr. Manto Tshablala-Msimang, declared TB an emergency in South Africa. Despite the rhetoric of urgency, the state’s response to the TB/HIV co-epidemic has remained sluggish. Increases in expenditure and resource allocation, as well as the collective commitment of the sate, the private sector and civil society to addressing the TB epidemic, are essential in order to lower infection rates to manageable levels.

Earlier this month, the South African National AIDS Council (SANAC) included TB as an official priority to be incorporated into all of its work. This was a clear attempt to combine broad-based responses to HIV/TB. But despite this positive development, the TB strategic plan of the Southern African Development Community (SADC) for 2007 – 2015, has devoted only 1% of its budget to TB/HIV collaborative activities. By failing to establish closer ties between the treatment of HIV and TB, resources will be wasted and access to treatment for both diseases rendered more difficult. This will be to the detriment of patient convenience, treatment adherence and ultimately disease control. For instance, HIV and TB are frequently treated at different healthcare sites in Southern Africa, with patients having to travel vast distances between the HIV and TB facilities at which they may receive treatment.

The ‘3 I’s’

The new Health Minister, Barbara Hogan, and her Deputy, Dr. Molefi Sefularo, have focused greater attention on the TB epidemic in South Africa. However, what is needed is a massive budget scale-up for TB services in conjunction with the establishment and implementation of what is known in public health as the ‘3 I’s’. These are: Intensified Case Finding (ICF), an effective Infection Control Policy, and a roll-out of Isoniazid Preventative Therapy (IPT), a prophylactic measure that reduces the risk of developing TB by more than 65%.

Intensified Case Finding involves screening all HIV-positive patients for TB at least every six months. The Department of Health reports that around 40% of HIV patients are screened for TB, while the WHO estimates this to be at less than 1% for South Africa. Regardless of the alarming discrepancies in these statistics, what is certain is that screening must be dramatically increased if deaths from AIDS/TB are to be reduced.

In the realm of treatment, Isoniazid Preventative Therapy (IPT) has been prescribed to only four per cent of HIV-positive South Africas. The state is therefore failing to provide this essential prophylaxis. IPT has the potential to reduce the risk of HIV-positive people developing TB by 65%, thus sharply decreasing HIV/TB mortality.

Improving infection control is a third imperative, as nosocomial TB transmission is common at South African healthcare sites. As the public ART roll-out gains momentum, increasing attention is being paid to the interaction of HIV and TB, and of the effects of the ART roll-out on the latter. In their article on TB infection control in resource-limited settings, Bock et al. have outlined the ways in which the very treatment initiatives created by the scale-up of ART have created ‘unprecedented opportunities’ for immuno-suppressed patients to be exposed to TB within healthcare facilities.[7]

Healthcare workers may also be HIV-positive, thus putting their own health at risk in treating patients with active TB, and reducing the productivity of the healthcare facility if they become ill with the disease while simultaneously presenting a TB infection risk to their patients.

Infection Control and Drug Resistant Strains

A recent study showed that a relatively low number of South Africa’s health facilities pass international infection control norms and standards. Despite popular misconceptions, Drug Resistant (DR) TB is not mostly caused by poor management of TB, but rather by primary transmission of the disease through poor infection control. In illustration of this, WHO figures show that 2,442 more cases of Multi-Drug Resistant (MDR) TB in South Africa are in new cases of TB as opposed to ‘re-treatment’ cases of TB.[8] This means that more people are being infected with MDR TB than developing resistance through poor adherence to treatment.

The TB/HIV Working Group of the WHO Stop TB Partnership has drawn up a series of guidelines on ‘Essential Actions for Effective TB Infection Control’, with a special focus on promoting safety without stigma. Their first recommendation concerns the necessity of patients being informed about their rights to rapid TB diagnosis and treatment, and of infection control through mask wearing and ‘cough hygiene’ (the covering of mouth and nose in order to prevent the spread of TB-infected droplets into the surrounding air).These guidelines explain that healthcare workers and patients must be taught that a request to wear a mask or to give a sputum test in a well-ventilated area is not an act of prejudice but rather a means of ensuring a safer clinic for everyone.

As the ART roll-out drives the establishment of new primary healthcare facilities in resource-limited countries, new healthcare sites are being established. Building plans and renovations must consider TB infection control as integral to the construction of new healthcare facilities, so as to ensure optimal natural ventilation.

The ‘Ubuntu’ Clinic

The waiting room of the ‘Ubuntu’ clinic in Khayelitsha (an informal settlement in Cape Town) is a model of TB infection control. There is optimal natural ventilation as the waiting room is outdoors, with heaters, blankets and a roof to protect patients from the elements.The Ubuntu clinic was established in 2003 by Médecins Sans Frontières (MSF) working in conjunction with provincial health authorities.

MSF has a record of remarkable achievements in South African public health. In April 2000, three ART pilot programmes were started by MSF as an adjunct to its primary healthcare centres in Khayelitsha. The purpose of their establishment was to prove that indigent patients could adhere well to ART treatment, in spite of the treatment’s complexities.[9] Due to the emergence of AIDS dissidence within high-ranking political circles, in addition to a lack of political will to respond to the increasing challenges of South Africa’s growing HIV epidemic, it would take a further three years before the state finally committed to the establishment of a national ART roll-out. However, the adherence rates documented in the MSF clinical study on ART were the highest on record when the results were published, overturning the notion that patients adhered better in rich world contexts and highlighting the centrality of effective treatment literacy.[10] The study proved that poverty level and locale were irrelevant to treatment success, but that educating patients in the basic biology of HIV and the importance of treatment adherence were vital.

At the Ubuntu clinic, MSF has applied the sound principles of patient education through treatment literacy, rapid initiation of patients onto the necessary therapies, and the decentralization of healthcare through increased reliance on nurses rather than doctors. The Ubuntu clinic, named after the African philosophical term which translates as ‘a person is only a person through other people’, is a model of integrated HIV/TB services in a resource-limited setting. Its popularity is illustrated by the fact that it is the busiest TB/HIV clinic with the highest TB cure rates in the Cape Town Metro region.[11] This model proves that, with good investments in interventions that result in the best patient outcomes, TB can be reversed.

TAC and TB

The Treatment Action Campaign (TAC) is an HIV activist organization which has won international acclaim for to its efforts in winning public access to ART in South Africa. TAC fights for the health and human rights of citizens, as enshrined in the Constitution. One of the TAC’s primary projects is its treatment literacy programme, whereby communities are educated about diseases through workshops and trainings, using materials which are understandable and accessible to South Africans from a broad range of educational backgrounds. TAC’s treatment literacy programmes also include information about TB, its symptoms, prevention and treatment.

At present, TAC is strongly advocating for better infection control at healthcare sites. TB is entirely curable and, in a properly functioning system, could be eliminated. However, this will take high-level commitment from government, healthcare workers, the private sector and partners in civil society to implement the strategies that will reverse the effects of the dual HIV/TB epidemics.

NOTES
1. S. Benatar, ‘Health care reform and the crisis of HIV and AIDS in South Africa’, New England Journal of Medicine (Vol. 351, No. 1, July, 2004), pp. 82, 85, 89 – 90.
2. Profile, South Africa, World Health Organisation, Available at http://www.who.int/globalatlas/predefinedReports/TB/PDF_Files/zaf.pdf
3. Gandhi, N.R; Moll, A.; Pawinski, R.; Sturm, A.W.; Lalloo, U.; Zeller, K.; Andrews, J.; Friedland, J.; High Prevalence and Mortality from Extensively-Drug Resistant (XDR) TB in TB/HIV Coinfected Patients in Rural South Africa, XVI International AIDS Conference, Toronto Canada. Available at http://www.aids2006.org/PAG/Abstracts.aspx?AID=51350
4. ‘Mortality and causes of death in South Africa’, 2005: Findings from death notification. P0309.3. Available at http://www.statssa.gov.za/publications/P03093/P030932005.pdf
5. ‘Mortality and causes of death in South Africa’, 2006: Findings from death notification. P0309.3. Available at http://www.statssa.gov.za/publications/P03093/P03093.pdf
6. WHO report 2008, ‘Global tuberculosis control - surveillance, planning, financing’. Available at http://www.who.int/tb/publications/global_report/2008/key_points/en/index.html
7. N. Bock, P. Jensen, B. Miller and E. Nardell, Tuberculosis Infection Control in Resource-Limited Settings in the Era of Expanding HIV Care and Treatment, Journal of Infectious Diseases (2007. 196, Supplement 1).
8. Anti-tuberculosis Drug-Resistance in the World, Report no. 4, World Health Organisation, 2008
9. Médecins Sans Frontières South Africa, the Department of Public Health at the University of Cape Town and the Provincial Administration of the Western Cape, South Africa, Antiretroviral therapy in primary heath care: the experience of the Khayelitsha programme in South Africa (WHO, Geneva, 2003), p. 2.
10. Médecins Sans Frontières South Africa, the Department of Public Health at the University of Cape Town and the Provincial Administration of the Western Cape, South Africa, Antiretroviral therapy in primary heath care: the experience of the Khayelitsha programme in South Africa (WHO, Geneva, 2003) p. 7; S. Power, ‘The AIDS rebel’, The New Yorker, 19 May 2003. Available at www.newyorker.com/archive Last accessed November 2008.
11. City of Cape Town Health Services, Médecins Sans Frontières and the Infectious Diseases and Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, ‘Report on the Integration of TB and HIV Services in Ubuntu clinic (Site B), Khayelitsha’ (Cape Town, November 2007), p. 2.

* Rebecca Hodes and Lesley Odendal work with the Treatment Action Campaign's Policy Communication and Research Department
* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/

HIV/AIDS and Africa’s military: Are we winning this war?

Azad Essa

2008-12-02

http://pambazuka.org/en/category/comment/52365

That HIV/AIDS has become a humanitarian and security crisis across the Africa is an indisputable fact.

Statistics aren’t likely to change overnight, and Africa remains the most affected continent with Sub-Saharan Africa accounting for more than 67% of 33 million HIV positive people across the globe. It is therefore no coincidence that HIV/AIDS is considered to be an incessant mode of destabilization on the African continent; an inherent security risk that threatens to disrupt gains in health, development, infrastructure and human development. In fact, while 25% of the continent remains engaged in conflict, in some quarters, HIV/AIDS is considered to be “more destabilizing than the wars currently raging on the continent”[1]

While debates continue - mandatory testing versus human rights; condoms versus abstinence and medical science versus traditional medicine - little is known regarding the extent to which African militaries, responsible for much of the rebuilding and maintenance of peace in post-conflict African states are being affected by HIV/AIDS. While concern over how HIV/AIDS affects Africa’s armed forces has increased since the late nineties, there seems to a plethora of gaps in the mainstream understanding of where African armies really stand, as a high risk population group.

HIV is a multifaceted virus, emerging and spread in varying contexts. Some of these include reasons include: socio-economic strife, mobile employment and high risk employment, high incidence of transactional sex and gender imbalances. Military personnel face all of these challenges, which inadvertently place them at the top end of high risk populations, together with truckers, miners and sex workers. What makes military personnel especially at risk is the amount of time spent away from home, stressful and difficult conditions and believe it or not, boredom and lack of entertainment that inadvertently provide military personnel, armed with financial resources, to wander off for sexual escapades. However, the difference between military personnel and the other high risk populations is essentially the crucial factor of secrecy that comes with being part of the military.

In fact, not only is the debate stunted by a lack of statistical data - the very nature of the military as instruments of public and yet national interest - make unearthing an issue like HIV in the military a rather complex affair. Both the military and HIV/AIDS are themes characterized with incessant concealment. HIV/AIDS is permanently surrounded by a cloud of Human Rights sensitivities; confidentiality clauses that serve to protect victims of HIV. This culture of concealment associated with HIV – good intentions granted – mixed with the culture of machismo-protection of military intelligence makes dealing with the crisis of HIV in the military even more intricate.


Without the right treatment, diet, living conditions and attitude, the virus is difficult to manage and affects the mental and physical capacities of HIV positive people. Living and working as a soldier requires the maximum capacities of reflex, concentration and patience that HIV easily undermines without the necessary treatment and counseling.

By implication, knowing the extent to which African forces are affected by the HI-virus is crucial for the continued development of the continent; the maintenance of peace and vanguard of rebuilding societies in post-conflict zones and for the very real containment of the virus in an ever shrinking world.

This paper seeks to make sense of the conundrum of opinion concerning the affect of HIV on Africa’s military and highlights how particular defense forces have, contrary to popular belief, responded to the crisis.


African militaries = HIV time bombs?

Even though statistics are difficult to collate, it was generally accepted that in peace time, defense forces across Africa have a HIV prevalence rate of 2 to 5 times the rate of their civilian populations. These statistics, from studies conducted in the late nineties provided the impetus for extreme blanket analyses that predicted the undermining of Africa’s security. This is now being widely contested as a generalization, with evidence suggesting that in South Africa, the rate amongst soldiers is marginally higher than civilians, while in the Ethiopian defense force, the rate is actually lower than the general population. But in Cameroon and Ghana – both with generally low prevalence levels – their respective armies had prevalence rates were one and half times, and two and a half times the general population[2] The general consensus therefore, is that African armed forces have a higher prevalence rate than civilian populations, but not necessarily 2 to 5 times their civilian prevalence rates.
And whilst these studies have been regarded as reliable data, there still remains significant confusion over the extent to which defense forces are affected. A clear example of this is the South African Defense Force (SANDF). It has been often suggested that HIV prevalence in the SANDF was abnormally high, between 50% and 70%, when official figures relay an estimate of 23%. Another prime example is Angola’s Defense Force, with initial estimates suggesting around 55%, when official reports indicate that rate is not more than 11%[3]. This is by no means an attempt to delegitimise largely accurate analyses or to subvert attention away from a crisis. In fact, according to the CHG Report [4], HIV prevalence of over 5% is already considered a significant erosion of operational capability, for ill-health does mean armies cannot operate at full capacity or be available for peacekeeping activities at the scale needed. Instead, the focus here is merely a reminder that statistics merely tell half the story, and need to be consumed critically.

In 2002 alone, the Malawian Defense force lost 131 personnel mainly to AIDS related illnesses. UNAIDS reported in 2003 that HIV was threatening to decimate more Malawians than any conflict the small nation has ever been involved in[5]. It was estimated in 2005 that HIV positive personnel in the Zambian Defense Force (ZDF) numbered more than the 16.5% that would be found in Zambia’s civilian population. As a result the medical service was said to be battling to provide the necessary HIV/AIDS related care to military personnel in need of medication, counseling and other types of support[6] that were crucial to keep personnel healthy, functional and in good spirits.

Likewise, it was revealed in early 2008 that approximately 55% of Zimbabwe’s troops were HIV positive, and up to 75% of these troops would succumb to the disease within the year. While reports indicate that the rate of HIV in Zimbabwe has reduced over the past couple of years, the Zimbabwe Human Development report indicates that infections in the military far outweighed the general population rate of 24.6%. According to the Pan-African Treatment Access Movement (PATAM), the situation was compounded by a lack of HIV/AIDS intervention programmes in the army[7]. This is hardly surprising, considering Zimbabwe’s current economic crisis. The World Food Programme announced in October 2008 that unless rapid supplies would arrive, Zimbabwe would run out of food by January 2009. The report further noted that the young soldiers recruited were trained to be fearless and aggressive, qualities they often carried into their personal, civilian and sexual lives.

As may be easily deduced, the situation in Southern African nations is far from ordinary or functional, with the impact on particular defense forces in the region highly suggestive of a crisis in these states. At the same time, the case of Southern Africa is hardly surprising, considering the incidence of HIV in the region itself, which is said to be a staggering seventeen times higher than the global average[8]. In 2007, 75% of all AIDS related deaths were located in sub-Saharan Africa, while according to 2002 South African government statistics; seven out of ten military deaths were AIDS related.

A study of returning Nigerian soldiers, conducted by the Civil Military Alliance to combat HIV/AIDS (CMA), found that rates of infection were double than that of Nigeria’s civilian population. Statistics in Cameroon point similarly to a clear difference between infection rates between civilian and armed forces. Here it is claimed that the civilian HIV rate in 2004 was around 5.6%, while armed forces were close to 15%. However, police recruits were 16.4% and truckers were found to be 18%[9]. As these statistics demonstrate once more, an uncritical approach towards statistics could easily conclude, in this case, that joining the army means a high probability of contracting HIV.

While evidence suggests this to be the largely the case, the case of Ethiopia’s HIV testing and prevention programme suggests that if emphatically addressed, this would remain but a generalization. But the Ethiopian case is a unique one, with even the nature of the war different to “normal” African conflicts which include violence spilling onto the general population.

Fresh evidence suggests that not only are African military forces in many other parts of Africa most definitely not in self-destruct mode as a result of HIV, but the rate of HIV does not compromise their effectiveness as a defense force nor does it spell the possibility of being invaded by an opportunistic warring nation[10]. Moreover, there are armies with effective but unpublicized HIV/AIDS programmes that are making a difference, defense forces that recruit rural youth with low HIV prevalence and conflict-affected populations with low HIV rates[11].

HIV/AIDS expert Alan Whiteside along with other authors drive home this point in a 2004 report in which they argue further that these alarmist views ignore the diversified nature of the HIV levels at different ranks, which are invariably differentiated by social context, demographics, patterns of deployment, amongst other factors[12]. This only serves as to provide an unsustainable concoction of realities on the ground. While rape and transactional sex are indictments to rising HIV rates across the continent, analysts would be hard pressed to disagree that HIV/AIDS has also been pinned as a justification for continued failure in the economy or political performance. At the same time, the evidence does exist (even if in sporadic accounts) that young men at war will indulge in unsafe sexual activities, increasing the chance of contracting HIV.

Recruitment, Care & Human Rights

The Inter-states Defense and security committee of the military health services working group (ISDC-MHS) was formed in 1999 to specifically but not limited to, addressing HIV/AIDS in the defense forces of the region but also towards managing malaria, diarrhea and stress management[13]. In January 2000, the UN Security council adopted Resolution 1308 (2000), indicating that the affect of HIV on the defense forces could be a threat to international peace. This resolution further indicated a shift from traditional understandings of security as absence of conflict to a more extensive understanding of human security. This resolution further obliged the UN to ensure that peacekeepers were trained and that countries supplying troops were given testing and treatment.[14] Commitment from the UN advanced a further level in 2001 when the General Assembly called on countries to integrate programmes and activities related to HIV for emergency contexts.

Between 2003/4, the African Union initiated the concept of an African standby force (ASF) as a means of organizing peacekeeping missions and launching the Common Security and Defense Policy (CSDP) towards developing a common defense and security guidelines. HIV/AIDS formed an important part of this policy and the initial guidelines for the ASF and its sub-regional brigades[15]. Of the more crucial aspects of this charter was the commitment that the adoption of the African Union’s standards for HIV and AIDS in peace support operations should equal or surpass those principals set by the UN. This naturally meant that all contributing or troops supplying countries had to develop HIV/AIDS policies and practices that reflected the standards of the UN and AU. The African union, acting on the advice of Lt-Gen. Tsdkan Gebretensae designed a “command centered approach” that focused on developing a set of seven policies.

AU’Command-centred approach[16]

1. Mandatory and voluntary testing
2. Admin & Management of treatment & the rights of HIV positive people
3. Human Resource Management & development
4. Budgeting
5. Rights of soldiers’ dependents & associated civilian population
6. Developing toolkits & to collate the fight against HIV/AIDS with core military
activities.
7. Create monitoring structure

Indeed, since 2000, more African defense forces have advanced on more serious HIV programmes and policies, sobering up alarmist analyses to a large extent. There was a shift and a refocus from the blanket approach to African militaries adopted by many analysts and the mainstream media in the nineties and even in the early turn of the 21st Century, where it was continuously bellied that all African forces were on the literal meltdown.

Ethiopia, South Africa, Senegal, Namibia and Zambia’s defense forces, amongst other countries, have all displayed an adeptness to respond to the AIDS pandemic, some, even before national government and even in contradiction to[17]. However, while certain African defense forces reacted positively towards the impending crisis, the vast majority of African defense force has reluctantly trotted along, paying the now mandatory attention to the virus.

The SANDF have run education and knowledge courses such as the Masibambisane “beyond awareness” campaign and Phidisa project outlined a 2004-2009 plan which sought to research and create health programmes to prolong the lives of HIV positive personnel. The Phidisa programme is specifically “focused on improved clinical management, psychosocial support, and the development of effective family-oriented care for HIV-affected military families”[18]. Phidisa set up six research locations to provide treatment to HIV positive personnel, as well as conduct research into other critical diseases affecting the military. According to Professor Lindy Heineckin, “military personnel also have to undergo a yearly comprehensive health assessment, and this includes an HIV test”

Certain defense forces, like the Namibian Defense Force developed a HIV/AIDS strategic plan 2004-2009 which focuses on prevention all the while aiming to the force’s ability to provide care, treatment and support services. Within two years of the programme, voluntary counseling and testing points were set up at all NDF sites and 40 unit coordinators had been trained. While the Namibian case showcases a proactive approach, there have been implementation and financial hassles.

According to Colonel Dr. Lawson Simapuka of the Zambian Defense Force (ZDF), HIV positive personnel are offered counseling and treatment, including ARVs to manage their health. While these soldiers are still deployed, their activities are confined to non-combat tasks.[19] But whilst these structures exist in the ZDF’s advanced HIV/AIDS programme, stigma and discrimination still endure, high levels of hospital admission remain debilitating and if a HIV positive soldier dies of an AIDS related illness, the family of the deceases does not receive full benefits.

In contrast, the Mozambican Military’s response to HIV/AIDS has been largely underdeveloped, with partnerships between local and international bodies only recently emerging. With the armed forces estimated at around 39%, AIDS is typically overburdening a health system that simply does not have a military specific health service[20] . However, what is specifically important to note is that the Mozambican response has failed precisely because of the nature of its generality, and lack of poignant attention to a specific population group.

Botswana’s Defense Force’s HIV/AIDS programme is reportedly a model of best practice and recommended, while the Umbutfo Swaziland Defense force’s (USDF) HIV/AIDS programme is also considered an example of good practice in managing the pandemic. Characterized by a strong focus on leadership, research and collaboration between state and non-state actors, the USDF policy seeks to address the entire cycle of human resource management, from recruitment to induction to mentoring[21]. But while the programme is said to be multisectoral, HIV/AIDS prevalence in the little Southern African kingdom hardly appears on the decline. Accessing the necessary data to showcase a possible improvement is problematic, hinting to the same syndrome most AIDS policies and initiatives suffer on the continent: the disease of rhetoric and inaction.

Unsurprisingly, with the effects of the disease in central and North African countries significantly lower than Sub-Saharan countries, defense forces, barring exceptions, of these regions have not approached HIV with the vigor it deserves. One of the more notable exceptions was the Moroccan Royal Armed Forces (MRAF), who had implemented a prevention programme as early as 1996. The MRAF’s peer advocacy programmes had reached over 60,000 soldiers, but a lack of funding ended the programme in 2001. Another positive case was the UN’s partnership with the Ethiopian National Defense Force (ECDF), which identified HIV/AIDS as a command issue in 1996 as well[22], and created a thorough prevention programme in 2001, which focused on testing. Similarly, the Ugandan People’s Defense Force (UPDP) have run a HIV programme since the late eighties, focusing on prevention through health education, voluntary counseling and testing, homecare and aimed at strengthening the military’s ability to run programmes[23]. Burkina Faso began an education programme in 2001, which fitted within the national anti-AIDS programme.

While the programmes have displayed political commitment in parts, the human rights dimension remains largely unresolved. The facts remain that African militaries are more likely to recruit and promote HIV negative personnel at the expense of HIV positive personnel. Human Right activists are vehemently in opposition to such practices, but the general conception is verily the notion of ‘fair’ discrimination, of which, most are willing apply in this case.

The fact remains that most African military forces screen for HIV as part of the recruitment process, whether secretly or not. For example, the Malawian army had recommended to government in 2001 to recruit only HIV negative soldiers, and while this hadn’t been passed by government, there were indications screenings were taking place with HIV being a key criteria. While the Malawian defense force has denied conducting these secret evaluations, they did admit that soldiers were put through a rigorous selection process with only those who were strong and healthy enough chosen. Similarly, while the Ethiopian programme has been lauded by many experts, human rights activists have expressed serious concern with the procedures, incentives and processes regarding promotions in the Ethiopian defense force. It was reported that the army uses HIV test results to sensitize personnel by suggesting in manuals and procedure documents that those who remain HIV negative would be regularly promoted while HIV positive personnel would lose such rights.[24] Interestingly, while the Uganda People’s Defense Force (UPDP) has posited a non-discriminatory approach to HIV positive soldiers, this programme still manages to direct less strenuous jobs for HIV positive soldiers, which effectively means HIV positive soldiers are discriminated - fairly or unfairly – dependent on your take on the human rights dynamics involved. But while the Ugandan programme aimed to reduce the rate of infections in the army, it aimed to do reduce the prevalence rater by also only recruiting HIV-negative soldiers, which, together with the existing plan of action of voluntary, anonymous and confidential HIV testing, is categorically unsustainable and contradictory.

Analysts argue that soldiers are more likely to contract HIV after years in the army and the issue should not be reduced to merely the time of recruitment. Therefore recruiting HIV negative personnel without enough processes, educative practices and capacity for treatment is short sighted and farcical. Following this line of thought, the All African Congress of Armed forces and Police Medical services found that Nigerian personnel have double the possibility of contracting HIV within three years of joining the army[25]. As an extension to this line of logic, if military personnel have a larger chance of contracting HIV during their time in service, surely it is an occupational hazard that the military cannot deny responsibility from?

Interestingly, the scenario becomes a tad more complex if one considers that the UN pressures the host country to conduct testing on troops before deployment for peacekeeping operations. While this is not a mandatory requirement, the UN highly recommends testing of peacekeepers before and after deployment, and while there has not been adequate post-deployment research conducted, evidence exists to suggest that even peacekeepers are responsible for the spread of HIV. Such practices continue largely uninterrupted, as debates still ensue regarding the military as a special case, especially with the type, cost and importance of the military to national interest.


The year 2008 did include a watershed event in the history of HIV/AIDS and the military. The SANDF, like most African defense forces, exclude HIV positive people from recruitment, foreign deployment and promotion. However, two HIV positive soldiers who suffered discrimination as a result of their HIV status took the SANDF to court in early 2008, to contest the SANDF’s policy on HIV-positive recruits. The South African High Court’s ruling affectively meant that the SANDF could no longer simply discriminate on the grounds of HIV. Moreover, within six months, the SANDF was tasked to amend its health classification policy that would allow for “individualized health assessments of recruits and current members of the armed forces”[26]. The end of this blanket approach to those with HIV is especially significant for Africa’s military; however, with six months already passed, the SANDF has yet to release their reviewed policy.

While human rights activists have lauded the ruling, the debate on the logic of such a ruling continues, especially with regards to the impact HIV could have on the readiness on a defense force with HIV positive soldiers and peacekeepers potentially weakened through HIV/AIDS and the related affects on the larger community. This might be so, but what this ruling serves to accomplish, is a shifting of mental models in the military to HIV. Whereas the military was able to reject and dispose of HIV positive people, this ruling forces the military to assume more leadership and responsibility to managing the pandemic within their ranks, rather than attempt to quarantine those with HIV in less strenuous positions or by refusing to recruit or promote HIV positive people within the military.

Conclusion

At the 2006 AIDS Conference in Toronto, the military was identified as both an important player in the fight against HIV/AIDS in conflict and post-conflict zones and if not managed, a serious violator in perpetuating the spread of HIV/AIDS, given the high-risk factors of military personnel[27]. At the same time, while HIV/AIDS was being taken more seriously by the Military, it was unanimously agreed upon that HIV prevalence rates had indeed increased in the military and peacekeeping forces and there was often complete denial of an urgent need to respond from certain military institutions[28].

The focus of the military towards HIV/AIDS has predictably leaned towards prevention rather than palliative, labour-intensive care. It is a no-brainer that Defense forces have and would look towards recruiting HIV negative soldiers and attempt to prevent a HIV positive soldier from completing rigorous tasks in the line of duty. ARV treatment is expensive and HIV/AIDS requires labour intensive care even if modern medication might allow HIV positive people live an ordinary, healthy life. However, the reality for many African armed forces as summed up by Prof Heinecken is that “the costs of managing this disease is beyond their administrative and financial capacity”, and the verdict is still out, regarding the normality of soldiers’ life in adequately dealing with the stress of managing HIV in a conflict zone.

HIV/AIDS is most certainly not a standard virus that is aggravated under predictable conditions. Thus while older and longer serving soldiers are more vulnerable to contracting the virus through unsafe practices, this is most definitely cannot be a standard conclusion. The conditions of deployment, quality and insistence of HIV prevention programmes and demographics of the army are therefore incumbent to understanding the intensity of HIV in the army[29].

In the developing world, HIV/AIDS is already acknowledged as an expression of socio-economic strife and the nexus between rising cases of HIV prevalence and poverty is not due to discontinue with the onset of the current worldwide recession and generally poorer socio-economic conditions, only serving as to make prevention and treatment programmes even more difficult to administer.

Addressing the issue requires out of the ordinary HIV/AIDS prevention and Human resource strategies campaigns. Since the military operates on a totally different set of rules, that are nonetheless governed by the national constitutions, African defense forces will need to specify what functional health ought to be, so that only HIV positive personnel in a latter phase of AIDS, with a rapidly depreciating CD4 count is sidelined from major army responsibility. A blanket approach perpetuates low self esteem, denigrates human rights and advances the notion of stigma.

Over and above the human rights implications, the tendency to isolate HIV positive personnel from core aspects of the army is most definitely not a solution. African militaries need to confront the pandemic with a multifaceted perspective that seeks to improve health care standards in conflict zones, while taking care to pay attention to finer details of providing contraceptives, sterile equipment and facilities that do not exacerbate the crisis[30]. Moreover, there needs to be shift in the manner in which HIV positive personnel are treated, in that African militaries must aim to address HIV sustainably and not through stop-start measures of blockading or denying entry to HIV positive recruits. This is also crucial in the larger struggle against stigmatization towards creating avenues for education and counseling to thrive.

As Peter Piot noted, “conflict and HIV are entangled as twin evils”[31], the advent of the AIDS has not only shifted weapons of war into new domains, the syndrome has also beckoned a rethinking and a challenging of preset ideas of war and impact on local space, both during and post-conflicts[32]. HIV/AIDS has shifted crucial components of armed conflicts: combatants, manner of conflict and social consequence[33]. It is an indisputable fact that HIV/AIDS has been used as weapon of war in Africa and this furthers a vicious cycle in which conflict and HIV/AIDS are accountable for affecting the effectiveness of national defense forces; negates economic development; stunts human and social development and leaves an implant on the local population.

Notes:

1. Heinecken (2001)
2. CHG Report 2008
3. Department of Defense online (2006)
4. CHG (2008)
5. Banda (2003)
6. Twinng Centre online (2005)
7. New Zimbabwe (2008)
8. Pharaoh et al (2003)
9. Forkum (2007)
10. Whiteside et al (2004)
11. CHG Report (2008)
12. Whiteside et al (2004)
13. Sassman (2008)
14. CHG (2008)
15. CHG Report
16. Adapted from CHGA (2008: 39)
17. Whiteside, De Waal and Gebre-Tensae, 2006).
18. Phidisa online
19. Simapuka (2007
20. Massinga (2007)
21. Gumede (2007)
22. CHG Report (2008)
23. CCR (2007) HIV/AIDS, Militaries and peacekeeping in Central and Eastern Africa
24. CCR (2007)
25. Fleshman (2001)
26. Skills Portal (2008)
27. AIDS 2006 online
28. AIDS 2006 online
29. (Whiteside, De Waal and Gebre-Tensae, 2006).
30. Elbe, S (2001)
31. Piot, P (2000)
32. Elbe (2002)
33. Elbe (2002)


References

1. AIDS 2006 online “Security and the Spread of HIV/AIDS: Challenging Military Leaders to Fight the Response” online under: http://www.aids2006.org/pag/PSession.aspx?s=159

2. Avert online (2008) “HIV and AIDS in Africa” online under: http://www.avert.org/aafrica.htm

3. Banda, C (2003) “Military losing war on HIV/AIDS” online under: http://www.newsfromafrica.org

4. BBC online (2004) Aids 'killing Africa's soldiers' online under: http://news.bbc.co.uk/2/hi/africa/3824875.stm

5. CHG Report (2008) Report of the Commission on HIV/AIDS and governance in Africa, UN Economic Commission for Africa

6. Department of Defense online (2006) “Winning battles in the war against HIV/AIDS” online under: http://www.med.navy.mil/sites/nhrc/dhapp/countryreports/Documents/yearly06/angola06.pdf

7. Elbe, S (2002). “HIV/AIDS and the changing landscape of war in Africa”, in International Security 27:2

8. Forkum, P. (2007). “The police and the fight against HIV/AIDS: Cameroon Case Study”, Trends, impact and policy development on HIV/AIDS and African armed forces Conference Proceedings (2007)

9. Gumede, N. (2007) “The case of the Umbutfo Swaziland Defense Force, HIV/AIDS and society: a perspective”, Trends, impact and policy development on HIV/AIDS and African armed forces Conference Proceedings (2007)

10. Heinecken, L (2003) “Aids: the new security frontier”, African Security Review, Institute for Security Studies online under: http://www.iss.org.za

11. Massinga, E. (2007) A perspective on HIV/AIDS and the Mozambican Armed forces, Trends, impact and policy development on HIV/AIDS and African armed forces Conference Proceedings (2007)

12. New Zimbabwe online (2008) “Over half Zimbabwe soldiers HIV positive” online under: http://www.newzimbabwe.com

13. Phidisa online “Media Release” online under: http://www.phidisa.org [Accessed: 22 November 2008]

14. Piot, Peter (2000) “The situation in Africa: the impact of AIDS on peace and security”, New York, Jan 10 2000

15. Reuters online (2008) SOUTH AFRICA: Military's HIV ban unlawful, online under: http://www.alertnet.org/thenews/newsdesk/IRIN/aa507d4b6ab23a4aecafbb9cda458555.htm

16. Sassman, C (2008) “Defence Health discussed by military forum”, online under: http://newera.com.na (19 November 2008)

17. Skills portal online (2008) “AIDS law project hails victory against SANDF”, online under: http://www.skillsportal.co.za (18 May 2008)
18. Twinning Centre online (2005) Providing HIV/AIDS Care to Zambia's National Defense Force, online under: http://www.twinningagainstaids.org/providing-hivaids-care.html
19. Whiteside, A; de Waal, A and Gebre-Tensae, T (2006) “Aids, security and military in Africa: A sober appraisal”, in African Affairs, Oxford University Press


* Azad Essa is a freelance journalist and researcher based at IOLS-Research, UKZN.
* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/

HIV and AIDS: A Very Short Introduction

Geral Caplan

2008-12-02

http://pambazuka.org/en/category/books/52368

In just 132 pages of text, the book covers the AIDS waterfront, though I suspect the volume's greatest appeal will be for those, like me, who come to the issue from a non-medical, non-scientific background and whose focus is Africa. Most of the book looks at the socio-economic components of AIDS and most of the examples are from southern Africa where, after all, the pandemic is at its most devastating and the needs are greatest. If prevention is universally needed, if all AIDS patients need proper treatment, good nutrition and adequate care, southern Africa needs more of everything, urgently and desperately.
Alan Whiteside has just published a short, punchy book appropriately titled HIV and AIDS: A Very Short Introduction.. It is now available online for the modest price of $10.00.

In just 132 pages of text, the book covers the AIDS waterfront, though I suspect the volume's greatest appeal will be for those, like me, who come to the issue from a non-medical, non-scientific background and whose focus is Africa. Most of the book looks at the socio-economic components of AIDS and most of the examples are from southern Africa where, after all, the pandemic is at its most devastating and the needs are greatest. If prevention is universally needed, if all AIDS patients need proper treatment, good nutrition and adequate care, southern Africa needs more of everything, urgently and desperately. Alan spells all this out in an unmistakable way, and while he mostly hides his well-known dry wit and passion under a cover of easily-understood exposition, they emerge regularly as sharp sudden stings at the end of a paragraph.

Alan grew up in Swaziland and now runs the Health, Economics and HIV/AIDS Research Division at the University of KwaZulu-Natal in Durban, South Africa. HEARD staff, under his supervision, conducts research on the socio-economic aspects of public health, especially the AIDS pandemic. Alan has been immersed in fighting AIDS for twenty years and has been writing about it regularly for fifteen. Over the years he has collaborated with some of the best thinkers in the business, co-authoring books with Nana Poku, Tony Barnett, Alex de Waal and Clem Sunter. So it was both an honor and no surprise that the Oxford University Press, publishers of the Very Short Introductions series of very short books, asked Alan to pen (keyboard?) their AIDS volume.

Let me draw attention to three of the main lessons that Alan derives from his long, often frustrating years of experience in the battle against AIDS. First is that leadership is crucial. Imagine living in a country whose president is an AIDS denier, one who appoints a Minister of Health who believes in quack therapies, who encourages crackpots and opportunists peddling phony nostrums, and delays by years the rollout of ARVs with incalculable consequences for his people. That was Alan's fate as he and thousands of other AIDS activists failed to move President Mbeki off of his perverse and fatal course.

Second is the need for gender equity, something that AIDS-Free World holds dear both as a moral position and for pragmatic reasons. HIV and AIDS will never be beaten so long as women are considered subordinate and unequal. Poor Alan and our many other friends in South Africa—out of the Mbeki frying pan into the Zuma fire.

Finally, with unusual but welcome harshness, Alan attacks prevention messages that focus on abstinence and fidelity as "unrealistic, hypocritical and stigmatizing". The emphasis, as he insists, needs to be on responsible sexual behavior rather than scare tactics. For this reason if no other, we need to be hoping that the Democrats win back the presidency in next November's American election.

Alan Whiteside's little book fits easily into a jacket pocket — okay, a man's jacket pocket — or even into a smallish purse. It can be carried around as a reference, with its many facts and figures and tables and its coverage of most of the key issues we all want to know something about. It won't make you an expert. But you'll know what you're talking about and you'll have a better idea of all the work we still have to do to wrestle this monster to the ground. You can hardly expect more from 132 pages.

HIV and AIDS: A Very Short Introduction is now available online for the modest price of $10.00.

No place left to bury the dead

Denial, despair, and hope in the African AIDS pandemic

Gerald Caplan

2008-12-02

http://pambazuka.org/en/category/books/52370

I came across this book, published sometime last year, completely by accident. Surfing for something else, I found an interview on National Public Radio in the US with Nicole Itano, a name I'd never heard before, discussing her book that I'd never heard of before. This is now the third popular study of AIDS in Africa in the past year, if we include Alan Whiteside's little book which, while more general, pays most attention to Africa.
I came across this book, published sometime last year, completely by accident. Surfing for something else, I found an interview on National Public Radio in the US with Nicole Itano, a name I'd never heard before, discussing her book that I'd never heard of before. This is now the third popular study of AIDS in Africa in the past year, if we include Alan Whiteside's little book which, while more general, pays most attention to Africa. Alan is widely known for his 15 years of leadership in the AIDS field and his HIV/AIDS: A Very Short Introduction, has a natural audience.

The second new popular book, of course, also included in our virtual book club, is Stephanie Nolen's powerful 28 Stories. Through the lives of 28 Africans (representing the 28 million Africans then thought to be infected with HIV), Stephanie tells the story of AIDS in Africa in all its grisliness. Given the reputation she had earned as the journalist who had publicized the pandemic in Africa more than any other in the world, 28 Stories arrived with a barrage of publicity. The endorsements on the jacket cover constituted a who's who of AIDS activists and other prominent humanitarians, from Bono to Emma Thompson to Aids-Free World's own Stephen Lewis. Not surprisingly, and entirely properly, 28 Stories has become a popular hit---not the usual result for a book on this topic.

And then, out of the blue, came Nicole Itano, with little advance publicity, no journal reviews that I've seen so far, no reviews on Amazon, and only one blurb on her book from Cornell West, an interesting, eccentric, progressive American academic/philosopher/activist but with no celebrity profile and, so far as I know, no great tie to the AIDS struggle. But here is Itano's No Place Left to Bury the Dead: Denial, Despair, and Hope in the African AIDS Pandemic , and I'm gratified to be able to report immediately that her book is terrific--- thoughtful, thorough, lucidly written, highly informative, and a perfect complement to Stephanie Nolen's fine effort.

In fact there are striking parallels between the two women and their books, not least that they are both North American reporters who lived in Johannesburg over the past several years and spent a great deal of time researching and writing about AIDS. And they cover at least some of the same territory. While Nolen's 28 stories include people in about a dozen countries in sub-Saharan Africa, Itano concentrates on three countries in southern Africa. They're three that Nolen also knows well---South Africa itself, Lesotho, and Botswana. But If the two women had any idea of the other's existence, or ever crossed paths, neither book reveals it.

For fortunate readers, the upshot of the two books is a wealth of learning of a genuinely original kind. We get to learn a great deal about AIDS, how it works, how it spreads, where it comes from. We get, especially from Itano, a deep, intimate look at the lives of three African women and their families and communities in a way that is rare and quite special; and we get the larger political context in which these people operate.

The cover blurb from Cornell West says the book gives us "ordinary people with extraordinary bravery and hope". I think it's probably obligatory to talk about bravery, extraordinariness and hope when reviewing this kind of book. It's probably obligatory for the author to do the same thing. But have no doubt—it's one of the great merits of Ms. Itano's book that she shows her subjects with warts and all. Many are not at all extraordinary, many are far from brave, and there is often little hope. There are even grannies who are shown to be drunk, callous and irresponsible. There's no doubt that in the past few years great progress has been made in the fight against AIDS in Africa, but in southern Africa much more suffering and death are still on the agenda, and will be for years to come. You'll get a better sense of their fate from the stories told be Nicole Itano.

Let me make two final comments about this book. First, a serious criticism. It has no maps. Readers have no idea where the characters can actually be found. This is frankly unfathomable to me, and should not have happened. It didn't happen in 28 Stories, which means Stephanie Nolen's editor did her work properly.

On a more general level, I'm greatly intrigued by Itano's title. Both halves of it echo titles right out of the 1994 genocide of Rwanda's Tutsi: The Graves Are Not Yet Full. Leave No One to tell the Story. And most famously, We Wish to Inform You that Tomorrow We Will be Killed with our Family. All are from real statements made by actors in the genocide drama, just as is No Place Left to Bury the Dead. And look at the sub-title: Denial, Despair and Hope in the African AIDS Epidemic. Unfortunately neglected now but a triumph when it was published only months after the genocide, a massive survey of the 100 days of slaughter produced by African Rights was titled Rwanda: Death, Despair and Defiance.

Nicole Itano has learned an impressive amount about AIDS and politics in southern Africa, but I've no idea whether she's read widely about Rwanda or has ever heard of any of these books. It seems to me unlikely that she'd come across the African Rights book, now sadly neglected. I think it's an interesting coincidence that she uses forms and language that sprang from the genocide, one of the terrible events of the last century. I think the AIDS pandemic, especially if you're watching it close up in the worst-affected countries of the world in southern Africa, might well make you think in genocidal terms. And just as the genocide was not about "ancient tribal rivalries" in which savage Africans simply slaughtered each other for no rational reason, so AIDS is not just about promiscuous Africans killing themselves and other Africans out of a lack of self-control and maturity. In both cases, the people who govern, many of the elites, those with power and privilege, have infinitely exacerbated the situation, either with their venality and hunger for power, as in Rwanda, or from indifference, ignorance, callousness or intellectual arrogance, as in many countries where AIDS has swept all before it. As with the 800,000 Rwandan Tutsi slaughtered in 1994, the women Nicole Itano introduces us to are not victims of unlucky fate. People with power are responsible for their suffering and death.

No Place Left to Bury the Dead: Denial, Despair and Hope in the African AIDS Pandemic is published by Atria; 1st Atria Books Hardcover Ed edition (November 20, 2007) ISBN-13: 978-0743270953
by Nicole Itano (Author)

Power, politics and HIV/AIDS in the African blogosphere

Dipesh Pabari

2008-12-02

http://pambazuka.org/en/category/blog/52371

“The powerful play goes on and you may contribute a verse”

About a year ago, CNN and Time declared the identification of male circumcision as a preventive measure against HIV infection as the biggest medical breakthrough of 2007. Having worked on one of the studies that led to this “discovery” several years before, I quickly penned something which was published on Africa News on the 20th December 2007 .
16th November: 0828 hrs
Google Search key words: HIV/AIDS Africa
Results: 17,340,000 for HIV/AIDS Africa. (0.07 seconds)

16th November: 0836 hrs
Google Search key words: HIV/AIDS Africa Blogs
Results: 1,140,000 for HIV/AIDS Africa Blogs (0.22 seconds)

21st November: 0659 hrs
Google Search key words: Politics and Power HIV/AIDS Africa blogs
Results: 418,000 for Politics and Power HIV/AIDS Africa blogs (0.16 seconds)

“The powerful play goes on and you may contribute a verse”

About a year ago, CNN and Time declared the identification of male circumcision as a preventive measure against HIV infection as the biggest medical breakthrough of 2007. Having worked on one of the studies that led to this “discovery” several years before, I quickly penned something which was published on Africa News on the 20th December 2007 (http://www.africanews.com/site/list_messages/14084).

What followed was an onslaught of comments prompting the publishers to keep the article open as a discussion. In this little microcosm of cyberspace, individuals debated the “truth” behind male circumcision as a potential preventative measure against HIV/AIDS. Right from the start it was clear that the readers of this forum were equally as concerned with the value of the science behind this declaration as they were with the power of agency and socio-political dimension that could have influenced and skewed the science in favour of male circumcision. To many this was a “western conspiracy”:

• “You need to be careful of these Americans who come to African forums to sell their ideas and to teach to the "stupid Africans."
• “Appeal to authority is nothing but intellectual laziness or incompetence. One should actually do a critical analysis of the evidence itself, and not rely on 'big brother" to do the thinking for them.”
• “.... For all the good work Stephen Lewis does he is a hypocrite in this case. He speaks against programs designed to promote behaviour change as being 'neocolonialist' yet sees absolutely no problem with telling African Men what they should be doing with their own bodies.”

Such reactions towards research in general are fairly common and well documented within medical anthropology journals and mainstream media. Four years before the article above was published, I had conducted an ethnographic study on people’s knowledge, attitudes and beliefs towards medical research using a trial on male circumcision as a case study in a town in western Kenya. For several months, I held hundreds of interviews and group discussions with the young, the old; the poor and the not-so poor; both men and women. More often than not, young urban youth in particular would make similar comments as the ones above. As an ethnographer, my job was to document and report my findings. The questions then and now is, are the presence of such perceptions important enough to address? Do such perceptions have any impact on the social acceptance of western models of research? Do populist opinions matter enough to scientists to actually address them?

I believe it is safe to say that beyond documentation, medical research has done little to address engaging with public opinion and understanding why communities hold such opinions probably because it rarely has a direct impact on the actual studies especially in poverty stricken environments. There is certainly never any shortage of participants willing to sign up to a study out of desperation for the paltry “benefits” offered (free medical care, transport fare, compensation for time). My experience conducting the ethnography showed that the very same young men who expressed their anger against western research stating that “we are just guinea pigs for the scientists” were the very same people lining up to participate in the study. This particular study has always been very pro-participant in terms of addressing their immediate needs such as setting up income generating activities; increasing compensation for time and providing medical care but the issue at hand in this particular paper is the impact web 2.0 is having on widening the paradigm of inclusion. Whereas once upon time, the academic ivory tower would have easily been able to ignore the populist paradigm, the increasing presence and public and accessible documentation of such discourse is pushing academics to engage and respond within a public domain. No longer can scientists hide within the exclusive world of journals and peer review or discuss amongst themselves such perceptions but now must engage the public domain whether it is conspiracy or not. I believe one of the main reasons for this is web 2.0 has allowed public opinion to infiltrate a paradigm that was once only reserved for scientists. What was once only orally expressed and taken and documented in the third person by researchers is expressed in writing first hand by the very people who voice these opinions. Simply put, the internet has allowed oral opinion to invade the stronghold of the written word and more importantly that oral opinion can be shared with millions around the world who would never have known what people at the grassroots actually believed or felt.

As stated in a conference paper by Luc Van Braekel, “The new age is the age of opinion not facts.”

Researchers are increasingly using web 2.0 tools. The Economist recently ran an article examining how web 2.0 is changing the shape of scientific debate: “With the technology in place, scientists face a chicken-and-egg conundrum. In order that blogging can become a respected academic medium it needs to be recognised by the upper echelons of the scientific establishment. But leading scientists are unlikely to take it up until it achieves respectability…Nevertheless, serious science-blogging is on the rise. The Seed state of science report, to be published later this autumn, found that 35% of researchers surveyed say they use blogs. This figure may seem underwhelming, but it was almost nought just a few years ago” (The Economist, September 2008). However, the issue at stake here is not about incorporating the tools within the exclusive domain of research but about using these tools to engage with the public sphere. Web 2.0 is a direct channel for anyone with access to the internet to interact and engage with one another on an equal ground no matter in what social category one is placed.

Blogging itself is an increasingly important paradigm for communications and it needs to be acknowledged and used. Today, there are over 72 million blog sites, making the practice of sharing your daily life and thoughts with the rest of the world one of the fasted growing areas on the internet.

Moreover, the impact of blogs on our world stretches beyond our immediate needs to be heard and is being used more and more to effect change. For example, the first blog-driven political controversy led to the eventual downfall of a U.S. Senate Leader exposed for his white supremacist sympathies. Just as one uses the mainstream media or traditional forms of communicating such as public gatherings, it is critical to use the World Wide Web. Just about everything that appears in the papers ends up being discussed on the internet whether on blogs, social networks, chat forums, comments, etc. Fine, this is the middle class who have a platform to voice their opinions and they are a minority of a minority in Africa but they are the ones that sit smack between the poor and the rich and connect those two worlds whether they are sitting in a bar and talking it through with a civil servant or when they return to the rural homes and sit with grandpa over a glass of a local brew.

As a blogger, I have been fascinated by the onslaught of blog posts, comments and campaigns (both for and against male circumcision) that have since emerged and for a brief time dominated the [public] sphere of public health. One particular post and the comments that followed caught my attention:
“Luo youths to disrupt a planned force[d] foreskin chopping exercise launching by VP ‘Judas Iscariot’ and Beth Mugo. Unsterile medical surgeon instruments and contaminated multi-dose vial are already in Luo land, reveals Luo Council of Elders” (MajimboKenya.com, 9th September 2008).

The title of this post says it all about the content of the article, but what is of more interest are the public comments framed in a political context. A few excerpts are reproduced below:

* “This is ridiculous for someone like Kalonzo and Mugo (Kenyatta family) to lead the onslaught on Luo chopping project, something is fishy. Luos should support the Mzee Riaga and stop this foolishness and useless political gimmicks.”
* “Akinyi, thanks for highlighting this subject. Luo must stand behind the Ker (Luo elder) and stop this act of dictatorship from Raila. Mugo is a circumcised women [sic] and she is being accused of secret women circumcision in Central Province, now the Luo are their project with Kalonzo. Luo women let us stand behind our Ker support our youths to stop this uncultural move the grand coalition.”
* “Anyang’ did not win any election in Kisumu Rural he was imposed on us by Raila. Now we can understand why Raila wanted him to be a minister of medical services, to help him circumcise Luo so that coming next election 2012 Raila wants to show Kikuyu how Luo men no more have a foreskin.(Foreskin vs. votes project). Raila should know that we are comfortable with being Kayi as the Kikuyus always call us. Raila will soon send Mungiki to force our women to circumcised just Mugo is doing in central province.”
* “I am again highly critical of the fact that our identity as a people and party is presently under discussion and considerable debate especially when it comes to this so called ‘circumcision’. I am looking at this as an attempt by some of us and our leaders to use our cultural and identity pillar as a tool that could be negotiated even in the elusive search for Kenya’s Presidency. This is unacceptable for it smacks of a deliberate and selfish move to bring the Luo under the hegemonic tutelage of other communities. I completely agree with the group that seeks to stop the dilution of Luo culture through the promotion of circumcision.


Since circumcision as a defining feature of one’s identity is so vital for those that maintain the practice as part of their ethnic identity, the discourse has become so embedded in the Kenyan social landscape partially due to the politicisation of ethnicity. The mutilation of non-circumcised Kenyans during the post-election violence attests to this and it is indeed a shame to see public reinforcement of the politicisation of what is essentially a public health issue coming from what one hopes would be a more informed community – i.e. the virtual community.

On the ground however, the reality has been very different. Hordes of young Luo men are prepared to wait hours and even days and, more surprisingly, are willing to take the chance of knowing their HIV status before getting circumcised regardless of the fact that, ‘knowing kills’ (a statement I heard so often regarding getting tested). I recently examined the reinvention of the cultural significance of male circumcision in an article published in Wajibu.

It is worth reiterating here that I never came across this sort of speak while interviewing people on a one to one basis or within Focus Group Discussions and neither did my fellow ethnographer while interviewing in Dholuo. Instead, what we found is that the majority of Luo say that culture/customs/tradition is not an important factor in deciding whether or not to circumcise. On a number of occasions when I explored this issue with informants these issues were raised only in terms of interactions with other ethnic groups, very broadly speaking in a sense of acceptance by “the other”. Unlike the comments above, the percentage of respondents that stated that they would not circumcise because it is not part of their culture was insignificant. On the contrary, I came across two Luo councillors who were very proud to state that they had been circumcised purely for hygienic and health reasons. One of the conclusions that we drew in our study was that simply adopting male circumcision does not diminish your cultural identity. Circumcision does not detract from the essence of what constitutes you as a person. The question is why, six years after the ethnography was conducted and male circumcision was publicly embraced was there a plethora of statements within the blogosphere against male circumcision based on culture and politics?

Given my involvement with the on male circumcision in Kisumu (western Kenya), I have maintained contact with the Principle Investigator and over the past year, we have had several discussions on the importance of scientists engaging within the blogosphere. From Prof. Bailey’s perspective, it is a question of whether the time taken to engage in the blogosphere is really worth it as he questions whether the blogosphere is reaching the necessary target audience (i.e. policy makers and implementers and local communities):

“First, how many people in Kenya really blog, and if they do blog, how many go to the site where you go? Precious few in the overall scheme of things…is it an effective way for me to spend my time if I want to influence people and policy? Do the MPs and Raila blog? I don’t think so. Does Mister Onyango tilling his shamba in Siaya blog? I don’t think so. Some poor STI-infested drunk poverty-stricken youth in Obunga blog? I don’t think so. For that matter, does the Ker blog? I don’t think so. One has to make choices about how one spends his time to be effective, and I am not convinced that blogging is IT. Similarly, if I had the money to hire someone to attend to the blogs – read them and write to them and post comments – would that be an effective way to spend our hard-earned funds rather than have that person out on the streets promoting circumcision or on radio or writing articles for the Nation. In Kenya, I don’t think so…”

My response to my good friend, Prof. Bailey:

“The medium is increasingly filtering through to the target audiences. Civil servants and civil society ranging from social activists to community health workers and public health researchers; employees and thousands of others sitting in offices are using the internet, and their perceptions are being influenced by what they read. University students would much rather spend 100ksh in a cyber cafe and download everything they need to cut and paste rather than spend hours in a library scanning through books looking for something to put in their papers. The PR machinery around politicians and all the other spin doctors and fixers are increasingly made up of young internet savvy people behind the scenes. I am not saying you replace one medium with another; I am saying we need to embrace this medium. How different would this be to what you asked me to do years ago: “Go and hang on the streets and listen to what people are saying and learn from them.”

* Dipesh Pabari is a Kenyan writer and freelance education and communications consultant.
* Please send comments to editor@pambazuka.org or comment online at http://www.pambazuka.org/

Africa: Traditional healers could play key role in ART rollout

2008-12-01

http://www.aidsmap.com/en/news/175A49F5-DCED-4644-BF39-1404839DEE15.asp

Traditional healers could potentially be an important source of HIV treatment in some African settings, according a study published in the December 1st edition of AIDS. Investigators from Zimbabwe and the University of Pennsylvania found that patients reported better quality of life after a visit to a traditional healer than did patients who accessed orthodox medical services.

Africa: Relentless fight against AIDS needed: Angelique Kidjo

2008-12-01

http://tinyurl.com/589jdh

Grammy Award winning singer and UNICEF goodwill ambassador Angelique Kidjo on Monday called for a relentless fight against AIDS in Africa, the world's most affected continent. "HIV-AIDS has become a huge issue for my continent and the fight against it must be relentless and determined," the Benin-born Kidjo told AFP in an interview to mark the World AIDS Day.

Africa: Will criminalising HIV transmission work?

2008-12-01

http://www.plusnews.org/Report.aspx?ReportId=81756

Countries in sub-Saharan Africa are looking at a new way of preventing HIV infections: criminal charges. But experts argue that applying criminal law to HIV transmission will achieve neither criminal justice nor curb the spread of the virus; rather, it will increase discrimination against people living with HIV, and undermine public health and human rights.

Global: HIV testing for mothers and children must expand, UN report shows

2008-12-01

http://www.aidsmap.com/en/news/590FF9FF-2F0D-46CA-ACC0-1FF79145A49D.asp

Access to HIV testing and antiretrovirals for prevention of mother to child HIV transmission has grown substantially over the past four years in the countries most severely affected by HIV, UN agencies reported today – but around 40% of women in the high prevalence countries of southern Africa are still not being offered an HIV test during pregnancy.

Global: "Quack Alert" - A film

2008-12-01

http://a24media.com/index.php?option=com_content&task=view&id=132&Itemid=127

By 1980 AIDS had spread to five continents around the world. Twenty eight years on there is still no cure although many people claim to have one. Thousands of people spend their life savings on ‘Quack doctors’ each year, with the belief that they can be cured. December 1st 2008 marks the 20th anniversary of World AIDS day. Runtime: 30 minutes.

Global: New HIV incidence analyses helps sharpen prevention efforts

2008-12-01

http://tinyurl.com/6pyaef

On the occasion of the 20th anniversary of the first observance of World AIDS Day, a new report by UNAIDS calls on countries to realign HIV prevention programmes through understanding how the most recent HIV infections were transmitted, and understanding the reasons why they occurred. “Not only will this approach help prevent the next 1,000 infections in each community, but it will also make money for AIDS work more effectively and help put forward a long term and sustainable AIDS response,” said UNAIDS Executive Director Dr Peter Piot.

Global: UNAIDS launches "Aids Outlook"

2008-12-01

http://tinyurl.com/5qs66x

AIDS Outlook is a new report from UNAIDS that provides perspectives on some of the most pressing issues that will confront policymakers and leaders as they respond to the challenges presented by AIDS in 2009. In many ways the year ahead will be a year of transition—and acceleration. Many countries are reviewing their national strategies on AIDS. Even though political commitment for AIDS is at an all-time high, recent developments in the financial world will test the resilience of many.

Global: World Aids Day - Statement by UN Secretary-General

2008-12-01

http://tinyurl.com/5vajdp

On this twentieth World AIDS Day, we are at the dawn of a new era. Fewer people are being infected with HIV. Fewer people are dying of AIDS. This success owes itself to people all over the world who are taking the lead to stop AIDS. Governments are delivering on their promises to scale up universal access to HIV prevention, treatment, care and support. But this is just the beginning. There is no room for complacency. AIDS will not go away any time soon.

Global: World Aids Day - Statement by UNIFEM Executive Director

2008-12-01

http://www.unifem.org/news_events/story_detail.php?StoryID=774

This year marks the 20th Anniversary of World AIDS Day. Looking back over the last 20 years, we see there has been progress — there is not only greater awareness of the gender dimensions of HIV and AIDS but also greater commitment to addressing these. But today, let us instead look forward, to what the world could look like 20 years from now, if we are able to deliver on these commitments. We would then have cause not just for commemoration but also for celebration.

Kenya: Where only HIV-positive people get beyond the velvet rope

2008-12-01

http://www.plusnews.org/Report.aspx?ReportId=81714

The party at a popular restaurant in Nairobi, the Kenyan capital, looks ordinary, but the people attending it - all of whom are HIV-positive - are enjoying a rare opportunity to socialise without feeling like an outsider. The young men and women spent the afternoon relaxing and getting to know each other; by the end of the evening new friends had been made, phone numbers exchanged and there were plans to meet again.

Mozambique: Proposed law a mixed bag for people with HIV

2008-12-01

http://www.plusnews.org/Report.aspx?ReportId=81755

Sixty years after the Universal Declaration of Human Rights and on the 20th anniversary of World AIDS Day, people living with HIV in Mozambique are still experiencing frequent human rights abuses. "There are signs that many people have been the victims of violence, or even lost their lives, for having gone public about their HIV-positive status," said Alice Mabote, president of the Mozambican League of Human Rights.

Mozambique: Widows risk HIV in purification rites

2008-12-01

http://www.plusnews.org/Report.aspx?ReportId=81496

When Mariana Uchandidhora's husband was killed in a traffic accident in South Africa a year ago, tradition required that she have sex with her deceased husband's brother in order to be purified. Uchandidhora, 36, refused, arguing that her brother-in-law was much younger than she was, but the family found an older man from outside the family to carry out the ritual, known as "khupita khufa". Two months later she discovered that she was both pregnant and HIV-positive.

South Africa: Living positively with my children beside me

“I” Stories

2008-12-01

http://pambazuka.org/en/category/hivaids/52359

I moved to South Africa 14 years ago from a very small country in central Africa. I always wanted to give my children a chance to grow up with a father figure since I had been a single mother for the first 15 years of their lives. I started corresponding with an old boyfriend living here in Johannesburg, and in January 1995, I visited him, rekindling the spark.
Living positively with my children beside me

by Blessings*

I moved to South Africa 14 years ago from a very small country in central Africa. I always wanted to give my children a chance to grow up with a father figure since I had been a single mother for the first 15 years of their lives. I started corresponding with an old boyfriend living here in Johannesburg, and in January 1995, I visited him, rekindling the spark.

We decided that I would stay to make a life together. Before long, in March the same year, my children came to live with us. Everything was going well until two months later when his true colours started to come out. He would leave the house in the morning around ten o’clock and only return the next morning at two o’clock, dead drunk. All his friends and acquaintances loved him because he would buy alcohol and even paid rent for some who could not pay for themselves.

However, at home we begged for money for food. In desperate times, I would actually steal it from him, especially when he was very drunk. I could not leave him because I had nowhere to go, and what made it worse, I was foreign and could not speak English.

Our life became unstable. During the period that I was with him we did not stay in a house for more than six months, we were always evicted because he did not pay rent.

This was not because he did not have money but because he just did not bother to be responsible enough to pay it. Sometimes we stayed in very ugly motels that you could never imagine. Sometimes he would come home drunk just to find us evicted outside. The situation became so unbearable that my children would go to the park and beg for money so we could eat. Instead of getting a new place to stay, he went and bought a new Isuzu 4x4 and took us to stay with his friend.

His friend got so tired of us that he moved out of his house leaving us there with nothing. So many nights he kicked us out of the house because we did or said something he did not like. This trend continued until 2000 when we moved into a furnished apartment South of Johannesburg. As always, he did not pay rent on time, but we were fortunate because our landlord was very understanding. He would kick him out but let us stay. Once the landlord 6 kicked him out and he said he would not pay unless he kicked me and my children out. At least by this time my children were working.

Because my children worked, we managed to pay the debt as well as the rent. Eventually he went his way, we stayed on our own. He went to stay in a very "low class" hotel in the east and carried on with his drinking and his wayward ways until he got very sick and needed me to look after him. We took him in and nursed him back to life.

At that point, he humbled himself and started working again but my children still paid

the rent. He then came up with the idea of buying a house. When the house was completed, he decided instead for his family to come live with him. My children and I accepted this because my children were working. My ex-boyfriend and his family then separated. He stayed in his new house and they found a house of their own.

He became sick and got worse by the day. He got weaker and weaker and had no one to look after him or cook for him, and he could not work. One day he visited us and continued to live with us. He deteriorated until he could not even go to the toilet on his own so much that he had to wear nappies. In 2004, he passed away.

After this, life had to go on, but I always felt this nag in my heart that I could be HIV positive, since I did not know what my late boyfriend suffered from. One day I shared my thoughts with my friend and my suspicions about the state of my health. My friend held my hand and accompanied me to get tested.

To my horror, my results came out positive. It was the most devastating news I could ever get. I prayed and asked God to carry my burdens for me and give me the courage to tell my children. Along came my colleague with whom I usually work who asked me to come along to a workshop that would present me with an opportunity to write my own story about my experiences.

After the first “I” Story session, I felt a sense of release after speaking out for the first time about my status, and immediately began my process of healing. I got the courage to tell my children. I thank God for my children because when I told them, they did not cry. Instead, they said, "You will make it, it’s not a death sentence all we have to do is change our lifestyle and be positive. Together as a family there's nothing we can’t beat, not even HIV can put us down.”

As I write my story, I feel good that my children have accepted my status. We eat healthy, exercise daily, think positive thoughts and give all glory to the Almighty.

* not her real name

Southern Africa: 95% reduction in 10 years possible with universal testing

2008-11-28

http://www.aidsmap.com/en/news/C94F6620-65FE-4F27-8129-4A26FB135E10.asp

Universal HIV testing and immediate antiretroviral therapy for everyone diagnosed with HIV in a country with very high HIV prevalence could reduce new infections from 20 per thousand to 1 per thousand within ten years (a 95% reduction), according to findings from a mathematical modelling exercise carried out by the World Health Organization, published on November 26th by The Lancet.

Southern Africa: HIV laws put women in the line of fire

2008-12-01

http://www.plusnews.org/Report.aspx?ReportId=81723

A woman in Malawi left her husband after years of abuse. He found her and raped her, an act not criminalised in Malawi when it occurs within marriage. The woman later tested positive for HIV and discovered that her husband had known his HIV-positive status for some time. When she confronted him about why he had infected her, he responded: "Because we must leave together".

Southern Africa: Hundreds of SADC media houses launch HIV and AIDS policies

2008-12-01

http://pambazuka.org/en/category/hivaids/52358

On 1 December 2008 over 130 media houses in 11 countries in the Southern Africa Development Community (SADC) publicly launched HIV and AIDS policies as part of commemorations to mark World AIDS Day. The climax of a three-year Media Action Plan (MAP) on HIV and AIDS and Gender, simultaneous launches will take place in the Democratic Republic of the Congo; Lesotho; Madagascar; Malawi; Mauritius; Mozambique; Namibia; Seychelles; Swaziland; Tanzania; and Zambia.
Hundreds of SADC media houses launch HIV and AIDS policies

Arthur Okwemba and Dumisani Gandhi

On 1 December 2008 over 130 media houses in 11 countries in the Southern Africa Development Community (SADC) publicly launched HIV and AIDS policies as part of commemorations to mark World AIDS Day. The climax of a three-year Media Action Plan (MAP) on HIV and AIDS and Gender, simultaneous launches will take place in the Democratic Republic of the Congo; Lesotho; Madagascar; Malawi; Mauritius; Mozambique; Namibia; Seychelles; Swaziland; Tanzania; and Zambia.

Following public events in each country, media managers, journalists, people living with HIV, care workers, and others from across the region connected in cyber space to discuss issues around HIV and AIDS and gender policy, and the funding of care work. Led by the Southern African Editor’s Forum (SAEF), MAP’s goal is for 80% of SADC media houses to have HIV and AIDS and Gender Policies by the end of 2008, recognising the importance of media in the regional response to the pandemic.

For facilitators working with media to put these policies in place, the going has not been easy, and the even more challenging task of implementation still lies ahead. “Having fantastic policies in place is one thing, but implementing them is totally different. This is the gap we need to urgently address,” says Eduardo Namburete, Senior Lecturer, School of Communications and Arts at Eduardo Mondlane University in Mozambique.

One of the biggest constraints to implementing policies, media managers say, is the lack of sufficient resources, especially in countries like Lesotho, where independent media houses often run their operations with little resources, both human and financial.

“The media houses have drawn up action plans that run up to between 2010 and 2015. But now the biggest constraint is lack of resources to implement them,” explains Sophia Tlali, Managing Director of KK Media and Editorial Services, Pvt. Ltd in Lesotho. Both Tlali and Namburete are working on the Media Action Plan (MAP) rollout in their countries.

Baseline data from research prior MAP’s launch in 2005 showed that HIV and AIDS constitutes less than 3% of all coverage in the region; only 4% of sources are people living with HIV and AIDS, and that media struggles to understand and reflect the gender dimensions of the pandemic. A similar study in three French-speaking SADC countries in 2007 produced similar results, showing that HIV and AIDS constituted a very low average of 2.1% of all coverage and that such coverage lacked depth.

Yet celebrations will come to naught if the brilliant policies are not implemented. Some aspects of policy implementation do not require resources, but just a change of mind-set among the media managers and journalists.

“Resources will always follow quality programmes and action plans, and media houses should explore raising resources from other sources,” says Colleen Lowe Morna, Executive Director of Gender Links. “For example,” she says, “the Malawi Broadcasting Corporation (MBC) has managed to raise resources from government and other sources to implement its policy.”

GL in partnership with the Media Institute of Southern Africa (MISA) leads the policy arm of MAP. Lowe Morna adds that National AIDS Councils and Commissions are emerging in some countries as potential sources of funds that media houses need to tap.

In Lesotho, Tlali has worked with media houses to develop proposals to the Lesotho National AIDS Commission requesting support for at least one HIV and AIDS broadcast programme every month, or a supplement on the HIV/AIDS pandemic in the newspapers.

“The other thing to do in terms of strategy,” adds Namburete, “is to put in place a system that tracks how media houses are implementing their policies, so that MAP does not end with just the adoption of the policy.”

While some media houses drag their feet on policy implementation, others are miles ahead. In Namibia, the Katutura Community Radio, winner of the 2008 Sol Plaatje Institute - MAP Gender, HIV and AIDS Institutional Excellence Awards, uses its policy to guide gender-sensitive HIV and AIDS programming targeting youth, the gay community and vulnerable groups. The station requires its news desk to ensure that 60% of coverage is on issues such as HIV and AIDS, gender, human rights, poverty, and education.

In Madagascar, the National Radio of Madagascar (RNM) is already implementing its policy adopted this year, airing several programmes on gender and HIV/AIDS. “Starting next year, we are going to have three programmes on gender and HIV and AIDS, and we will intensify the involvement of employees in the fight against the pandemic,” says Harrison Ratavondrahona, a reporter at RNM.

Some media houses are more receptive to the idea of policies around HIV and AIDS, rather than gender. “There is this misconception among male media managers that introducing gender policies are a strategy to help women take over their influential positions,” says Gladness Mumo, Coordinator of the Media Institute of Southern Africa’s (MISA) Good Governance project in Tanzania.

It remains to be seen whether these policies will have an impact on how media treat HIV and AIDS and gender. However, more needs to be done to ensure that HIV and AIDS and gender are mainstreamed into media practice and in the coverage of all other topics. This requires more than a policy. It requires political will from the media and continuous training of media practitioners to ensure they are able to handle the ever changing discourse on HIV and AIDS and gender.

The adoption of policies by these media house symbolises a bold step by media to play a positive role in reducing the spread of HIV and mitigating the impact of the pandemic. However, policies alone will not be enough, but with adequate training for media mangers and journalists and effective implementation they will ensure a systematic and more effective response to HIV and AIDS by the media in the region.

* Arthur Okwemba is a Kenyan journalist with the African Woman and Child Feature Service. Dumisani Gandhi is the HIV/AIDS and Gender, and Media Manager and Gender Links. This article is part of a series produced by the Gender Links Opinion and Commentary Service for the Sixteen Days of Activism

Zambia: Cultural approach to HIV and AIDS prevention

2008-12-01

http://portal.unesco.org/en/ev.php-URL_ID=44095

UNESCO’s culture and HIV and AIDS programme is developing and testing a toolkit on the use of arts to address HIV and AIDS-related stigma and discrimination in Zambia. The objective of the toolkit is to generate discussions and exercises facilitating learning and enhancing knowledge of key issues concerning HIV and AIDS related stigma and discrimination through arts.

Zimbabwe: "He begged for forgiveness and I did just that"

2008-12-01

http://www.plusnews.org/Report.aspx?ReportId=81750

The story of Samuel and Stella Malunga* is one of love and forgiveness in a time of HIV and AIDS. They met and fell in love while studying law at a university in neighbouring South Africa. Samuel graduated two years before Stella and returned to Zimbabwe but kept their relationship going until she was able to join him in 2000.

Fahamu