Tag: HIV and Aids

The sound of Aids: Lesotho’s mourning bell

(Pic: Flickr / World Bank)
(Pic: Flickr / World Bank)

During summer in Lesotho, the perfect time to go running is just before 6am, when the sun has reached a point where it warms the earth without damaging the skin; and just before the traffic of a thousand textile factory workers swarms the road. Five days a week at six in the morning, I go for a run. I pass suburban lawns, the police training college, a small village school and The Clinic. At this clinic, I hear sounds that I recognise from many places, but never bother to identify. The sounds of a creaky wire gate, the voice of an eager vetkoek hawker, a gurgling baby on its mother’s lap, cold instructions from a male nurse, the moaning of a tired and thin woman, the tuberculosis cough of an old man and, as  always, the frightened silence of desperate hope. All of these, to me, resemble the sound of Aids.

This sound is loud as it is soft. It is as ordinary as it is uncanny and only those who have heard it before will recognise it. One recent morning, I ran my daily route past the clinic and was annoyed that my earphones were failing to block out the sounds around me. That was when I heard it, this repetitive and unchanging sound of Africa’s silent massacre-leader. I ran faster because I recognised it – I was not in the mood for a reminder. On the way back from my running loop, I decided to stand at the corner of the fence surrounding the clinic. I was compelled by curiosity. After all, this impulse kills cats and not humans.

There were those oh-so-familiar sounds again: the gate, hawker, baby, man, moan, cough, and silence, all at once. The noises were coming from faceless figures, someone’s mother or uncle or niece. I tried to catch pieces of dialect, everyone seemed to be discussing everything but the reason they were there. One woman was joking about how, during the 1998 Lesotho Riots, she used to ward off soldiers with her rear end.  Another was telling the uninterested boy beside her how Basotho love the word of God but detest God himself. There was a man holding a newspaper with the headline ‘Lesotho food security at risk’. Everything seemed so normal, only it wasn’t. Of the first 10 faces I looked at, about seven had hesitant and pained expressions painted on. Not the kind of angst that comes from telling a big lie, or running out of money mid-month, but the kind that screams “Surely Not”.

I’d witnessed this kind of angst plenty of times while working shifts at my mother’s pharmacy. My mother maintained my grandmother’s vision of having a pharmacy that keeps its prices especially low in order to make medicine accessible to the poor. Lesotho’s poor, who account for most of the population, have a painful and neglected history with medicine. Anti-retroviral drugs (ARVs) have become a sort of staple on the government’s agenda. This dates back to the early 2000s, when there was a limited supply of the drug and it was matched with the greatest despairing demand. In order to ration supply, many laws were put into place with the intention of serving those who were most affected first; or most affluent, depending on where you were standing. During this period, only certain districts were able to receive and distribute ARVs. The problems that followed still linger in the morgues of Lesotho’s hugely successful funeral businesses. The knowledge of this information makes working at my mother’s pharmacy a bittersweet and tiring experience.

My trip down I’ll-never-work-for-my-mother-again lane was cut short by an irritating political campaign car blaring some half-baked manifesto through a megaphone. It was so loud and imposing. The sound shook me and I decided to continue with my run. I couldn’t help but lead my mind back to the leaking promises that were being yelled through the megaphone. Lesotho is a boisterous arena and the world watches as kinsmen pit themselves against each other to ensure mutual defeat. The greatest tragedy is that in this battle, the voices of politicians and their empty-vessel promises mute the sounds that deserve attention. The sounds of persistent hawkers, tired moans and violent coughs. The whimpering of thirsty issues, drowned out by the overflow of political manifestos.

It was not curiosity that stopped me outside of that clinic that day. It was the innate response of a Mosotho deafened by the continuous and corrupted clatter which filters through the radio stations, televisions, newspapers and megaphones. An automatic reaction to a battle between two voices: one booming and the other broken, neither making any sense. I stopped outside the clinic that morning because Lesotho is mourning, and I needed to mourn with Her. The sobs of the nation are not loud and desperate like the fatal promises of the politicians. Rather, they are quiet and tired, resembling a morning run or the sound of Aids.

Tsepiso Secker is final year economics student at the University of Cape Town. She is a citizen of the beautiful mountainous Kingdom of Lesotho but spent most of her schooling years in South Africa. She occasionally writes for The Money Tree magazine. Connect with her on Twitter: @Tsepspeare

Zambia: Teens turn to text messages for Aids advice

An Zambian HIV counsellor looks at phone text messages coming up on the U-report platform for HIV and Aids awareness at a call centre in Lusaka. (Pic: AFP)
A Zambian HIV counsellor looks at text messages coming up on the U-report platform for HIV and Aids awareness at a call centre in Lusaka. (Pic: AFP)

The questions teenagers ask about HIV are brutally honest, anonymous – and sent in 160 characters or less over mobile phone text messages.

At U-Report, a Zambian HIV advice organisation, thousands of bite-sized questions come through every day.

One asks, “I have a girl who has HIV and now she is talking about marriage what can I do with her?”

Another wants to know “when you kiss someone deeply can it be possible to contract the virus?”

Though Aids-related deaths are significantly decreasing internationally, they continue to rise among adolescents, according to a Unicef report released last week.

But services like U-Report are offering a new way to get through to teens too afraid or too embarrassed to talk to health care workers face-to-face.

Located in a nondescript office building in Lusaka, the counsellors sit behind desktop computers answering SMS queries on everything from how the virus is spread, to the pros and cons of male circumcision.

Launched in 2012, the service now boasts over 70 000 subscribers and is being used as a model for other countries, including South Africa and Tanzania.

“We are receiving messages from all over Zambia,” said manager Christina Mutale. “It went viral.”

Significantly, a third of participants are teens, those most likely to die from Aids.

Sitting in a garden outside the Lusaka clinic where she receives her treatment, U-Report user Chilufya Mwanangumbi said counsellors could be hard to find.

High infection rate
With purple-painted nails and dreams of being a civil engineer, the 19-year-old student is one of Zambia’s many teenagers living with HIV.

“At other clinics, they don’t tell you what to do, they just tell you you’re positive and send you home with the drugs,” said Mwanangumbi.

“That’s when people kill themselves – because they think it’s the end of the world.”

UNAIids, the UN agency battling the disease, estimates 2.1 million adolescents are living with HIV in 2013, 80 percent of them in sub-Saharan Africa.

Zambia has one of the highest HIV infection rates in the world – an estimated 13 percent of its 14 million people are infected.

Signs of the epidemic are everywhere.

In the Saturday Post newspaper nearly half of the classifieds section is filled with adverts for herbal cures for HIV and Aids, alongside remedies for  wide hips and reclaiming lost lovers.

And while U-Report is starting to address the teenage HIV crisis, the barriers to success in the country are high. Even if teens get access to counselling, they may struggle to find a suitable clinic in Zambia, where there is a chronic shortage of doctors and health workers.

Medical services and technology
Yet there has never been a better time for a mobile phoned-based counselling service.

By the end of 2014, there will be more than 635 million mobile subscriptions in sub-Saharan Africa, a number set to grow as phones become cheaper and data more readily available, said Swedish technology company Ericsson in a recent report.

Zambia’s text message experiment is part of an international trend that is seeing medical services being provided via technology, with digitally savvy teens the quickest to adapt.

“The long-term findings on adolescents, health care and computer technologies is that they often prefer them to face-to-face communication,” said Kevin Patrick, director at the Centre for Wireless and Population Health Systems at the University of California, San Diego.

“They will more likely confide in a computer about sensitive issues.”

And as Zambia wrestles to shore up its overwhelmed health care system, inexpensive mobile technology could help ease the strain.

“Apps exist to help people locate the closest HIV testing site,” said David Moore, a professor at the University of California, San Diego, researching mobile technologies and HIV. “What if you could do something like an HIV rapid test using an app on your phone? That could be a game changer in terms of HIV incidence.”

We’re falling into Ebola’s trap because we didn’t learn from the Aids epidemic

A medical worker checks his protective clothing  at an MSF facility in Kailahun, Sierra Leone. (Pic: AFP)
A medical worker checks his protective clothing at an MSF facility in Kailahun, Sierra Leone. (Pic: AFP)

I can’t help but notice the similarities of the world’s reaction to Ebola today and to Aids 30 years ago.

When Aids first appeared in the early 1980s, scientists explained that the disease was transmitted primarily by sex, blood transfusions and shared needles.

But, in fear of the deadly disease, many were quick to blame gay men, sex workers, Haitians and Africans. Some suggested that Aids was God’s punishment for sinful sexual behaviours.

In the first decade of Aids, we let ignorance, indifference, hate, stigma and discrimination guide us. We missed the point. World action started late, and we lost millions of people to Aids.

Finally, in the 1990s, it became obvious that HIV and Aids could affect married couples, pastors, sport stars, hemophiliacs, rape survivors and children. Children like me.

I belong to the first ever generation of children born with HIV. As a child, I was very thin and my classmates called me names, like “skeleton” and “Aids”. I would go home and tell my dad. He would comfort me, saying: “You can’t have Aids, it’s for older people, you are just a kid, you are my little queen.” He would kiss me and hug me and make me forget the bullying.

Blame and shame
I became an activist when I was 18 years old. I didn’t and still don’t like the Aids image in people’s minds. Some quickly ask: “How did you get it?” When I say I was born with HIV, they keep asking: “Who brought HIV into your family?” and often jump to conclusions, like “Men are unfaithful”, suggesting my dad was a bad guy.

My dad wasn’t a bad guy! He was infected and affected by HIV and the world didn’t assist him much. Instead they judged him and called him names. As I look back, I realise all he went through, raising me as a single father when my mum died, burdened with guilt and guided by love, convincing me to take medication and answering my questions. He died painfully from Aids 17 years ago and I still miss him.

One day, at an Aids conference in Rwanda, I met a distant aunt. She started describing my dad as an evil man who had infected my mum and me with HIV. With tears in my eyes, I refused to listen.

It hurts when people fail to understand the pain my dad went through and to acknowledge that he raised me lovingly and gave me everything I have now, from my name to my education.

With Ebola, some are acting like my aunt, stigmatising Ebola sufferers, survivors and caregivers.

We can’t fight an epidemic by ostracising affected communities. We can only win if we let science and compassion guide our interventions.

The Ebola epidemic is proving that the world hasn’t changed much. We are quick to stigmatise, discriminate and criminalise affected communities.

African boys are bullied and called Ebola at American schools, a volunteer saving lives in West Africa is unreasonably quarantined in the USA, and visa and travel bans punish citizens from Ebola-affected countries. Do people really think they can create a safe haven by shutting out others?

An MSF medical worker feeds a child at an MSF facility in Kailahun on August 15 2014. Kailahun along with Kenama district is at the epicentre of the world's worst Ebola outbreak. (Pic: AFP)
An MSF medical worker feeds a child at a facility in Kailahun, Sierra Leone on August 15 2014. Kailahun along with Kenama district is at the epicentre of the world’s worst Ebola outbreak. (Pic: AFP)

Stigma, discrimination, travel bans and prejudice won’t solve Ebola.

Instead, we should unite against the HIV and Ebola viruses. We can do more, and better.

“The AIDS disease is caused by the HIV virus but the Aids epidemic is caused by HIV and Aids- related hate, indifference, stigma and discrimination and criminalisation,” said singer Elton John.

The same applies to Ebola. Let’s not fall into Ebola’s trap. We can’t afford to lose more people by ignoring science and conceding to bigotry and stigma.

Claire Gasamagera is an HIV activist from Rwanda, with a degree in food technology and a passion for defending the rights, health and dignity of young people living with HIV. She is the founder of Kigali Hope Association, which later became Rwanda Young Positives. 

Kenya: Putting an end to transactional sex and letting girls be girls

It was a Facebook message from Liz Moran at the Women’s Institute of Secondary Education and Research (Wiser) that prompted me to research and write this article.

Part of it read: “Many girls engage in transactional sex in order to pay school fees or buy sanitary pads resulting in some of the highest HIV rates in the country (38%). The barriers for female education are so strong that in 30 years, only one woman from the community had attended University.”

This is happening in Muhuru Bay, a town in the Nyanza Province of Kenya. It is situated on the banks of Lake Victoria, close to the Tanzanian border.

The facts haunted me. Young girls engage in sex with fishermen in order to pay for school fees or sanitary towels. And it gets worse: women fishmongers in the fishing communities commonly form relationships with fishermen to secure the rights to purchase the fish they catch and then sell them in the market. The sex exchange typically occurs in a hurried manner, often without preparation or protection. As it compromises their ability to practise safer sex, men and women in these fishing communities are at increased risk of HIV.

Given the nomadic nature of the fishing community here and a lack of education about HIV and Aids, it is thus not surprising that out of at least every ten people, about four of them are HIV positive. Recent figures from the Kenya National HIV and Aids Estimates say that Kenya has the fourth highest HIV prevalence in the world, with about 1.6 million people infected with the virus. Of these, an estimated 191 840 are children.

In the larger Lake Victoria region, it is also common for women and girls to have sex with fishermen to obtain food, or to get fish to sell in order to pay for medicine or school fees. Therefore, it is necessary to break this cycle by offering a solution to at least one of the challenges.

Wiser seems to have found a good one.

“We run an entirely free high school for girls in Muhuru Bay, a fishing village in rural Kenya,” Moran told me. “Girls here rarely complete secondary school. They are forced into marriages, become pregnant, drop out of school to enable their brothers to continue, suffer physical and psychological abuse, and have a general lack of support and positive female role models.”

Students at Wiser. (Pic: Supplied)
Students at Wiser. (Pic: Supplied)

In 2006, Dr Sherryl Broverman, co-founder of Wiser, discovered a note that was slipped under her door while she was in Muhuru Bay doing research. “Should I stop having sex with the man who is paying my school fees? I am afraid of getting Aids,” it read. The note was from a 14-year-old girl.

In 2007, Wiser was formed to empower young girls in Muhuru Bay through education. Here girls would be offered a chance to study for free as well as get hands-on skills in agriculture, reproductive health and engineering. The girls would be removed from the environment that predisposed them to health risks, lack of education and instead get a chance to be girls.

The Wiser school in Muhuru Bay provides clothes, sanitary pads, books, healthy food, supportive teachers, mosquito nets, and medicine. About 150 girls have gone through the school, and girls who are pregnant are also welcomed. The school offers counselling and psychosocial support for its students while also helping them realise their talents and leadership skills. According to Wiser and Kenya’s Ministry of Health, this region has the highest HIV, malaria and infant mortality rates in the country.

“Our maiden class graduated this year in March and all the 28 girls passed their final Kenya Certificate of Secondary Education and 17 have qualified for university,” said Moran. “We know that those are girls who will lead their families and communities. They are innovative – some are making solar powered items from recycled materials.”

Members of Wiser's Engineering Club. The girls have created flashlights with locally available materials which they hope to franchise. (Pic: Supplied)
Members of Wiser’s Engineering Club. The girls have created flashlights with locally available materials which they hope to franchise. (Pic: Supplied)

Evidently, Wiser has long been living up to this year’s International Day of the Girl Child theme, ‘Empowering Adolescent Girls: Ending the Cycle of Violence’. By creating a fee-free secondary school, the organisation is changing the notion of what is possible for girls in Muhuru Bay, and also ending the vicious cycle of transactional sex and gender-based violence in school.

“Before coming to Wiser, the girls were in schools where their teachers touched them inappropriately and others were raped. Due to this, some dropped out. Here, we take a deliberate initiative to protect the girls while in school and we minimise their time out of school as well,” Moran said.

Girls around the world still face discrimination simply because they are girls. As we mark International Day of the Girl Child on October 11, the reality is that there are those who may still have to trade their bodies for a pen, a book or a sanitary pad. Fortunately for the girls in Muhuru Bay, they have one less challenge to overcome. Their education is being catered for and they are gradually being empowered to make their own informed decisions.

Hopefully when the UN Women Executive Director Phumzile Mlambo-Ngcuka marks the day at Unicef, she will challenge each and every one of us to empower our adolescent sisters. We may have resources that we can share to educate them. We may mentor them, we may share our experiences with them, so they could learn from us and us from them.

There is a need for a generation of young girls who are actively involved in their well-being and who are proactively taking steps to end the cycle of violence and inequality. And then, they need to carry it forward to those who come after them.

It is my hope that young girls across Africa will stop exchanging sex for any basic commodities, not merely because of the risk of HIV and Aids or pregnancy, but because they do not have to.

Eunice Kilonzo is a journalist in Kenya.