Tag: HIV

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. 

Uganda tests out rubber band circumcision

With trousers around his ankles, Justin Igalla awaits a tight rubber band for his foreskin, an innovative non-surgical technique rolling out in several African nations to encourage circumcision and cut HIV infection rates.

The simple device – two plastic rings and an elastic band – cuts off blood supply to the foreskin, which then shrivels and is removed with the band after a week.

“I felt nothing, not even a little discomfort,” Igalla said after a procedure taking just minutes, noting there was no blood – unlike traditional circumcision where the foreskin is sliced off by knife – thus reducing the risk of infection.

Igalla, a father of two, said he opted to have his foreskin taken off for “health reasons”.

Scientists have found that male circumcision can significantly reduce the chances of HIV infection because the foreskin has a higher concentration of HIV-receptors than the rest of the penis and is prone to tears during intercourse, providing HIV an entry point.

As well as Uganda, the device is being used in Botswana, Kenya, Mozambique, South Africa, Zambia, Zimbabwe and other sub-Saharan countries. All have been identified by the World Health Organisation (WHO) as “priority” states where the risk of acquiring HIV is high and male circumcision, and access to conventional surgical procedures, is low.

Uganda hopes the device, called PrePex, will convince adult men to be circumcised as part of the battle against Aids, now resurgent in the East African nation after years of decline, with as many as 80 000 people dying of the disease every year.

PrePex, a non-surgical circumcision device. (Pic: AFP)
PrePex, a non-surgical circumcision device. (Pic: AFP)

From a peak of 18% infected in 1992, Uganda’s “ABC” strategy – Abstinence, Be faithful, Condomise – helped slash rates to 6.4% in 2005.

But rates have crept back up, to 7.2%  in 2012. As many as 1.8 million people in the country now live with HIV, and a million children have been orphaned after their parents died of Aids.

The makers of PrePex boast that a man “can resume work and almost all daily activities shortly after the procedure,” with the device “designed to be placed, worn, and removed with minimal disruption”, although they should abstain from sex for six weeks afterwards.

Doctor Barbara Nanteza, male circumcision project manager at Uganda’s Aids Control Programme, said that trials had shown that circumcision reduced risk of transmission from a woman to a man by as much as 60 percent.

Although some contest the validity of these studies, WHO and the United Nations Aids programme push circumcision as an additional prevention measure in high-prevalence countries where HIV transmission is predominantly heterosexual.

The WHO says there is “compelling evidence” circumcision reduces risk of heterosexually acquired HIV infection in men. The organisation has “prequalified” PrePex, meaning the device has been assessed and meets international standards for efficacy and safety.

And with health budgets already overstretched, the device offers a cheaper way to tackle the problem, Nanteza said.

“If circumcision can help reduce the cost, that could very good for the country,” she told AFP.

Uganda, long praised for its efforts in the fight against Aids, launched a general circumcision programme in 2010, when some 9 000 had the conventional treatment.

Since then 1.2 million men have been circumcised – or 13% of men over 15, including 800 000 last year alone, the health ministry said.

The introduction of the PrePex device is expected to boost numbers even further – but it’s still not enough, according to Nanteza.

Though the device greatly reduces the pain of traditional circumcision, she conceded the issue remained an awkward one for married men.

“It is difficult for them to explain to their wife that they want to get a circumcision to prevent HIV infection when they are supposed to be faithful to them,” Nanteza said.

Despite massive health awareness campaigns, problems remain.

James Brian, a counsellor with the Walter Reid Project, a US-based medical organisation supporting the programme, said it was essential to emphasise that while circumcision reduces the risk of infection, it does not prevent it.

“After circumcision someone should not think that they are immune against HIV,” Brian said, who works with patients to highlight the continuing need to practise safe sex.

Emmanuel Leroux-Nega for AFP

Alarm as Uganda moves to criminalise deliberate HIV transmission

Activists in Uganda, where HIV prevalence is on the rise, have warned that new legislation criminalising deliberate transmission of the virus will further undermine efforts to stem the Aids epidemic and erode the rights of those living with HIV.

As well as setting out fines and jail terms of up to 10 years for those found guilty of “willful and intentional” transmission, the HIV/AIDS Prevention and Control Bill, passed by Parliament on May 8 and now awaiting presidential assent, also obliges pregnant women and their partners to take HIV tests, and in some circumstances empowers health workers to unilaterally disclose a patient’s positive status to an at-risk partner or household member. It also obliges parents to tell their children of their status.

“Despite years of engagement and labouring to explain the dangers on an HIV-specific criminal law, Parliament has refused to be advised. When experts on HIV research and management attempted to speak, [lawmakers] still failed to heed to the key concerns,” Dorah Kinconco Musinguzi, executive director of Uganda Network on Law, Ethics and HIV/AIDS (UgaNet), told IRIN.

“If we have not managed to test 67% of Ugandans for HIV without a law that punishes transmission, will this number improve when citizens know that more legal burdens are added to testing? The answer is no. Will their behaviour improve because of this fear? No. Will we have helped the HIV situation then? No. We shall have more people transmit HIV in ignorance of their status. Laws do little to change behaviour, instead it takes behaviour underground,” she said.

Over the past five years HIV prevalence in Uganda has risen from 6.4% to 7.3%.

“The evidence from the Ugandan Ministry of Health shows clearly – criminalisation of HIV doesn’t work. It drives people away from services and fuels discrimination and fear,” Asia Russell of the HIV advocacy organisation Health GAP, told IRIN.

(Pic: Mujahid Safodien / IRIN)
(Pic: Mujahid Safodien / IRIN)

Alex Ario, the national co-ordinator of the ministry’s AIDS Control Programme (ACP), said “the Bill may not be that useful in my view. It does not add value to the current efforts. Actually, with dwindling support from donor communities to ACP as it is now, we would rather divert efforts to lobby government of Uganda to put more money for HIV activities rather than legislating against people with HIV.”

“We need to redirect legislative reform, and law enforcement, towards addressing sexual and other forms of violence against women, and discrimination and other human rights violations against people living with HIV and people most at risk of exposure to HIV,” he said.

Russell added that in conjunction with the Anti-Homosexuality Act, which passed into law in February 2014, this new law could lead “a sex worker apprehended for sex work, who is transgender and HIV positive, [to] be sent to prison for life.”

UgaNet’s Musinguzi said: “This [Bill] will hurt the women we have been encouraging to come up to take an HIV test such that they can have HIV-free children. But in this case, they will be forced to disclose their results and should they fear, and not do it in time, that means that they are potential candidates for [prosecution under] the Bill…

“There is high likelihood that justice will not prevail for the HIV-positive [people] found in this situation because of the high levels of stigma and condemnation that we have seen the HIV-positive go through,” she added.

More than 150 000 people are becoming HIV-positive every year; 1.5-million Ugandans are HIV-positive, according to Uganda Aids Commission statistics.

The Bill also flies in the face of the “rights-based” approach to HIV embodied in the regional HIV/AIDS Act passed in April 2012 by the East African Legislative Assembly.

Those in favour… 
Meanwhile, some MPs have been defending the Bill.

“Every piece of legislation is to prevent mischief. The Bill is both [a] legal and moral thing. We want to reduce down HIV deliberate infections,” Medard Lubega Ssegona, opposition shadow minister for justice and constitutional affairs, told IRIN.

“The Bill will encourage more people to go and test for their good. It will compel two consenting adults to test before they engage to each other because of the sanctions of false disclosure,” he said, adding: “The deliberate infections have caused a lot of burden [on] our economy. The government spends a lot of money on treating and taking care of people who have [been] deliberately infected by people with bad hearts. This is going to stop.”

Olivia Kwagala Kabaale, a legislator from the ruling National Resistance Movement party, said: “The mandatory disclosure will help to protect those who take care of the HIV sick people. Some of these people don’t want to disclosure their status yet they pose a risk of transmission of the virus to others.”

Laws in Burundi, Kenya and Tanzania also criminalise deliberate HIV transmission, leaving Rwanda the only member of the East African Community not to do so.

The new Bill also establishes the legal framework for an HIV Trust Fund to finance local-level programmes using money generated by levies on bank transactions and savings interest, air tickets, beer, soft drinks and cigarettes, as well taxes on goods and services traded within Uganda.

“The Bill is creating [an] HIV trust fund which is going to help the government raise local funds to support the HIV programme. It’s a right time for us now as a country to mobilize our own resources to fight the epidemic. We have been depending on donor support for our HIV fight,” said Kabaale.

Teenagers, risky sex and pregnancy in SA

How is it possible that we know the correct behaviour or the healthiest practice and yet we don’t follow it? Is it human nature or just a lack of discipline?

I’m guilty of this when it comes to my weight. No amount of knowledge I acquire or books I read can help me get off my roller-coaster ride of weight gain and loss.

I see teenage pregnancy in South Africa in the same light. Having loads of information about it is not enough to change our behaviour. One would think that young people today have enough tools to avoid unwanted pregnancy: contraception is available and sexual health information is a fingertip or a cell phone away. But many girls still fall pregnant before finishing high school. In 2009 alone, more than 49 000 schoolgirls, mostly black and poor, gave birth in South Africa, according to the United Nations Population Fund. This not only endangers their education and their future, it  also places a huge burden on their families.

(Pic: AFP)
(Pic: AFP)

That number of 49 000 pregnant schoolgirls means that as many boys and men impregnated them. Hey, it takes two to tango.

Why does this happen? What perpetuates this cycle?

An insightful 2009 study by researchers Jewkes, Morrell and Christofides aptly summed it up: “Teenage pregnancy is not just an issue of reproductive health and young women’s bodies but, rather, one of its causes and consequences, rooted in women’s gendered social environment.”

Sad but true. Our environment influences young women hugely. In some South African communities, young women are pressured to prove their fertility at a young age, and so they fall pregnant, simultaneously risking contracting sexually transmitted infections and HIV.

And if that’s not enough, they are often left to raise the babies alone because the father is “unknown” – meaning he is either married, or not ready to assume this responsibility, or does not want a child, or is still too young so he gets to continue with his education – while she (the expecting mother) likely drops out of school to care for the baby.

In addition, young women have to wrestle with the societal expectations that they must be conservative and passive.

We are also expected to prove our social status – to look a certain way, wear certain clothes, and be seen possessing certain material things.  Dating someone older to provide these status symbols or necessities seems the easier route – no matter the cost.

However, experience has taught me otherwise: nothing is ever for mahala, meaning there are no freebies in life. What you do today will determine your future.

These were the figures reported about HIV in South Africa by the Human Sciences Research Council:

  • Among teenagers, girls have eight times the HIV infection rate than their male peers.
  • Girls aged 15-19 are more likely than boys the same age to have sex, and sex with older men.
  • Condom use has dropped significantly among young people.

To change this gut-wrenching reality, we must ask some hard questions:

  • Can we honestly see progress in South Africa when so many girls still fall pregnant and/or contract HIV daily?
  • Can we not take advantage of the booming social networks and other creative platforms to create safe spaces for dialogue around the real reasons why young black girls are falling pregnant today?

We should change our way of dealing with this sensitive social issue. Let us be less prescriptive about the young girls’ behaviour and meet them where they are.

Hearing their voices when messages and programmes are designed will help us address the real issues behind teenage pregnancy in South Africa.

To walk the talk, I am developing an interactive session for a group of high school students aged 14-17 in Braamfontein, Johannesburg. We use applied drama and theatre methods to build a platform for dialogue around teenage pregnancy. I’ll keep you posted.

Zandi Mqwathi  is a confident, innovative young leader and a former radio personality with a zeal and drive to use her craft and experiences to educate and empower other young women. She writes for Countdown to Zero, a  Unicef/Inter Press Service project.

Culture clash over tribal wife-swapping in Namibia

Wife-swapping among Namibia’s nomadic tribes has been practised for generations but a legislator’s call to enshrine it in law has stirred debate about women’s rights and tradition in modern society.

The practice is more of a gentlemen’s agreement where friends can have sex with each others’ wives with no strings attached.

Swinging with an African tribal touch? Or “rape”, as some critics see it.

The wives have little say in the matter, according to those who denounce the custom as both abusive and risky in a country with one of the world’s highest HIV and Aids rates.

But the Ovahimba and Ovazemba tribes, based mainly in this southern African country’s arid north, contend their age-old custom strengthens friendships and prevents promiscuity.

“It’s a culture that gives us unity and friendship,” said Kazeongere Tjeundo, a lawmaker and deputy president of the opposition Democratic Turnhalle Alliance of Namibia.

“It’s up to you to choose (among) your mates who you like the most … to allow him to sleep with your wife,” said Tjeundo, a member of the Ovahimba ethnic group.

Concerned that HIV and Aids could be used as an excuse to stop the ancient tradition, he and others are suggesting regulations be adopted to ensure “good practice”.

Tjeundo said he plans to propose a wife-swapping law, following a November legislative poll when he is tipped for re-election.

Known as “okujepisa omukazendu” – which loosely means “offering a wife to a guest” – the practice is little known outside these reclusive communities, whose population is estimated at 86 000.

Mainly found in the northwestern Kunene region near the Angolan border, the tribes are largely isolated from the rest of the country. They have resisted the trappings of modern life, keep livestock, live off the land and practice ancestral worship.

A woman from the Ovahimba tribe. (Pic: Flickr / Martha de Jong-Lantink)
A woman from the Ovahimba tribe. (Pic: Flickr / Martha de Jong-Lantink)

Many still reside in pole-and-mud huts and both men and women go bare-chested.

The women wear short skirts of goat skin, carved iron and cowshell jewellery and cover their braided locks in thick red ochre paste, which they also rub on their skin as a sun screen.

Unlike any modern-day swinging, tribal members make no random draw to pair couples. They meet in their own homes, while the husband or wife of the other party is banished to a separate hut during the exchange.

‘Not benefiting women’
Women cannot object to sleeping with a man chosen by their husbands, a point that angers rights activists like Rosa Namises who says the custom is tantamount to rape and “rape is illegal”.

“That practice is not benefiting women but men who want to control their partners,” said Namises, a former lawmaker who heads a non-governmental organisation called Woman Solidarity Namibia.

Other groups like Namibia’s Legal Assistance Centre (LAC), a public interest law firm that vows to protect the rights of all Namibians, have challenged its continued existence in a country where 18.2% of the 2.1-million residents have HIV, according to national statistics.

“It’s a practice that puts women at health risk,” said Amon Ngavetene, who is in charge of LAC’s Aids project. He contends that most women are opposed to the practice and would want it abolished.

But 40-year-old Kambapira Mutumbo is completely comfortable with the custom and has been asked to sleep with her husband’s friends.

“I did it this year,” she said, and “I have no problem with the arrangement.”

“It’s good because its part of our culture, why should we change it?” she added.

Cloudina Venaani, programme analyst with the United Nations Development Programme office in Namibia, is adamant that women only tolerate it because they are afraid of defying their husbands.

Traditionalists, however, insist the custom does not violate the rights of women, noting that women are also free to choose partners for their husbands – even if this rarely happens in practice.

Like opposition lawmaker Tjeundohe, Uziruapi Tjavara, chief of the Otjikaoko Traditional Authority in the Kunene region, wants the custom to continue but paired with education on HIV.

Details, however, are still vague.

“We just need to research more on how the practice can be regulated,” said Tjeundohe.

Shinovene Immanuel for AFP