Oxfam visited the densely populated and poor northern province of Zambezia in Mozambique recently to see how PEPFAR and other US agencies work on the ground. At the sites we visited, we found a close level of collaboration between PEPFAR and the Mozambique Ministry of Health. Over the past two years, the Mozambican government has worked to integrate all donors into its national development plans. Donors like PEPFAR have been asked to make some changes in the way they operate. PEPFAR aid to Zambezia province reflects PEPFAR’s ensuing move to integrate AIDS care into the long-term health system. To fight HIV/AIDS in Zambezia, Population Services International (PSI) implements PEPFAR programs ranging from those preventing the transmission of HIV from mothers to babies during pregnancy, to providing HIV counseling and testing, to preventing HIV through theatre and classroom presentations.
Sixteen percent of the adult population of Mozambique is HIV positive. In some areas, infection rates are as high as 20 percent. In 2000, only 1,000 Mozambicans were on anti-retroviral therapy. PEPFAR programs have increased those numbers to nearly 160,000. PEPFAR funds have also financed care and support for about 800,000 people living with HIV and their families.
Development experts worry that PEPFAR may not be the kind of program that leads to long-term health and development. PEPFAR is often criticized as the textbook "vertical fund," which bypasses the government and creates a parallel health care system. Critics of these so-called vertical funds have pointed out that foreign aid donors sometimes pour all of their health funding into treatment of one disease. This can have the unintended result of neglecting basic care for the general population and hiring away health care workers from general medicine clinics to HIV clinics, leaving the general medicine clinics understaffed.
Donor resources for HIV have outpaced support for basic health care for all Mozambicans. In 2007, only 3 percent of US foreign aid to Mozambique was for child and maternal health, while 61 percent went to HIV/AIDS. But more people in Mozambique are affected by child and maternal mortality than by HIV, since 15 percent of Mozambican children do not reach their fifth birthday and the mother dies in one out of every 100 births in Mozambique.
In the small town of Maganja da Costa, there is a PSI building next to the government health clinic that used to offer free counseling and testing to people who suspect they have HIV. The building bears a freshly painted sign. The sign used to read "HIV Counseling and Testing," and now it reads "Health Testing Center." At the request of the Mozambique Ministry of Health, PSI has expanded services offered there to include cancer, diabetes, and tuberculosis screenings. The change is a result of a recent Ministry of Health policy of integrating stand-alone HIV "day clinics" into the general health system, including centers funded by donors. Integrating these HIV day clinics into the general health system reduces the stigma attached to getting tested, since it's no longer obvious that if you walk into that building, you are there to test for HIV and HIV only. Making the building a generic testing facility, and not just an HIV one, provides new testing capacity for the government health clinic.
PEPFAR is also working to integrate health care workers into government clinics, rather than hiring away the best staff for separate clinics. PSI has implemented this change on the front lines: its nurses are embedded within government clinics, wearing the same uniforms as government employees and providing the same services.
In the district hospital in urban Quelimane, PEPFAR's contributions to basic health are also on display. There, PSI uses PEPFAR money to fund two nurses and a physician's aide—a big addition to the original staff of eight. PSI also renovated the maternity ward, and Columbia University (using PEPFAR funds) transports blood samples to the lab, which is hours away. Support like this from PEPFAR makes it easier for the clinic to serve the more than 260,000 people depending on it for all their health care needs.
"PEPFAR support actually benefits other areas in the clinic. We now have pre-counseling in addition to testing, which we didn't have before, and we can now test for other sexually transmitted diseases as part of antenatal care because we have additional money for other testing." — Director of Government Clinic, Maganja da Costa
When we arrived in one town, PSI insisted that our first destination be the government clinic, where we asked the clinic's director for permission to visit. Visitors can be disruptive, preventing doctors, nurses, and health workers from seeing patients. Asking permission also reminds visitors and nongovernmental organizations that this is the government's clinic and that even though PSI may have outside money, its role is to help the government of Mozambique provide health care and not the other way around.
While we heard concerns from international donors based in Maputo that PEPFAR is not fully integrated into the Mozambique Ministry of Health and National AIDS Council, the experience of health care workers in the field appeared to be one of close collaboration and integration. The change is due to two key innovations:
PEPFAR's evolving role in Mozambique is a model for other PEPFAR focus countries, particularly the countries that have only just begun to hold donors like PEPFAR accountable to their national health priorities.
]]>"In the southern part of Mozambique, HIV prevalence is going up, in part because of the traditional practice of having more than one long-term partner. So, the government of Mozambique, besides promoting condom use in a large scale, it is planning to promote a massive campaign on multiple and concurrent sexual partnerships. Now, concerning the scaling up of condom promotion, some partners, mainly PEPFAR, have not picked this up among their priorities. Rather, they preach abstinence and faithfulness. Meanwhile, support for procurement of medicines has been to push us towards the use of brand name drugs. I've been listening to the donors over the last 15 years telling us they want to listen to what the government wants—is this true or is it just rhetoric?
"We can plan by ourselves, we know our HIV priorities. When it comes to best practices, listen to us. You cannot just read the books that are written elsewhere in Europe or America, you have to experience what we do on a daily basis. You have to be integrated into the socio-anthropological mindset of people in order to make sure that the messages that you leave in the community pass through the generations."
"Sometimes it's difficult for all the donors to coordinate—they agree to do so, and then they just continue to follow the same practices as before. The Global Fund has signed the MOU [Memorandum of Understanding], but they insist on keeping bilateral contracts with both the Ministry of Health and the CNCS, so the Mozambican government has to do duplicative reporting to the Global Fund.
"What the US's PEPFAR has done does make sense in some ways. The capacity building process with PEPFAR is good, and there are also programs that I would say are very good, like the CDC's support to the Ministry of Health for prevention of mother-to-child transmission. However, here in Mozambique we have the Memorandum of Understanding and a general code of conduct for HIV work. Most partners have signed both, while the US has only signed the code of conduct. PEPFAR is about 70% of donor funding for HIV/AIDS in Mozambique. The other donors who signed the MOU represent only about 30% of aid to HIV in Mozambique. PEPFAR is a huge funding stream that doesn't align with the MOU.
"If better coordinated, I think PEPFAR's results could be more visible and better. PEPFAR's particular weakness as far as I am concerned resides in sharing information. Sometimes we only know something is happening when they ask us to just endorse whatever they want to do. Until they send us a letter or even a phone call: "Diogo, you know, there is another amendment in our support, an increase in our funding for HIV/AIDS. Could you liaise with the Ministry of Foreign Affair so as to see this process signed up..." I definitely have to do that, because at the end of the day, the money benefits our community and my people. But in doing that, I'm not saying that we are better coordinated, no, I still complain."
"There's another way that things should be: you have to come into my planning cycle and tell me that, look, I'll be intervening here and there, and therefore, if you have some priorities here, tell me, so that I don't put emphasis on those type of areas where the Americans or whomever are already working.
]]>These community organizations are the leaders in an epic struggle against HIV and AIDS in South Africa. They are doing what the government cannot seem to do: deliver essential services that directly benefit the millions of people in the country infected and affected by HIV/AIDS.
"If the government of South Africa wants to address HIV issues, then it needs to strengthen community-based organizations," says Gerard Payne, who works for the AIDS Consortium, a national organization that supports thousands of community groups. He says that the HIV/AIDS crisis is the most significant challenge facing South Africa since the transition from apartheid.
The scale of the problem requires a local, grassroots response, and community organizations are doing their best to deliver it. Many are overcommitted and underfunded. "Whether it is through financial resources, whether it is through training, we need to strengthen them, so we can reduce the rate of HIV in this country," Payne says.
Payne has just been to visit one such community organization, where he stood in the dusty courtyard outside a two-room cinderblock house in South Africa's North West province as a dozen high-energy toddlers played and ran around him. Four of the organization's home-based care givers prepared to make their rounds, visiting patients in their homes to help cook, clean, and remind them to take their medication.
Payne's job at the AIDS Consortium is affiliate coordinator, so he visits the community-based organizations, assesses their needs and capabilities, and recommends a course of action to train the staff. Many must learn and implement procedures for raising and managing money, and develop a strategic vision for what the organization can be and where it can go. This helps the community organizations get past simply reacting to the HIV/AIDS crisis and working towards measures that will help improve the situation.
One example is in the care of orphans and vulnerable children in the community. The government of South Africa estimated last year that there are 1.5 million children under 17 directly affected by HIV: one or both parents are dead, or they are living with the virus themselves. With so many children now in need of a place to live, or at least hang out after school, get a meal, and stay out of trouble, it is the community organizations that are struggling to meet this need, many of them without specialized training or adequate funds. "They may be running a program, but have no idea how to really do it properly," Payne says. "So we will help them get training so they can provide counseling and other services that will help the children. We help them get to a level where they have good infrastructure and are rendering quality services." This can include a curriculum to teach "life skills" to young people so they can learn how to prevent HIV.
Another essential area where community groups can make a big difference is in helping people living with HIV and AIDS to understand what treatment is available and how to get it—a basic level of knowledge known as "treatment literacy." This is particularly helpful for women, who for reasons related to poverty and discrimination may be unable to get to a clinic or hospital—their families may not give them time, they may not have money to pay for transportation, or they may just simply not know that they are HIV positive and need medication.
Gerard Payne says that even if a patient can get to a hospital, he or she still may not understand what they need to do to stay alive. "Patients go there, the staff does a CD-4 count and gives them some medication, but they do not explain anything," Payne says. "Our objective is to educate organizations how to help patients understand the different treatments needed, and their rights to access treatment."
He adds that educating people about their right to treatment is a big step for many groups that are accustomed to delivering food and other care. "Community-based organizations respond to needs: if someone is sick, they go to them once or twice a week and take care of them," he explains. "We are saying they need to take it a step further. That patient is eventually going to get really ill, so they need to understand what care is available, where to access it, and that they must adhere to the treatment."
Seeing organizations grow and become more effective is one of the things that keeps Payne engaged in his work. "Last year I had one affiliate with no money, so I helped them get financial management systems in place," Payne says. "The first 1,000 rand [US $125] they raised was due to the fact that we showed them how to open up a bank account and write some letters to raise money."
"The joy and satisfaction I get comes when someone tells me that the work we do is making a difference," Payne says.
Payne says that South Africa is at a crucial stage in its history. "We have come a long was as a country, and struggled through many hardships," he says. "We are now in a different kind of struggle, and I want to be able to feel that I am contributing in the struggle against HIV."
]]>Mogale, 37, is open about her status: she has been HIV positive for two years, and she is living with it. After all, she is doing better now and hopes the worst is behind her. "Now I am really fit compared to when I was sick—I can go a long distance walking now," she says. She regularly walks about one and a half miles to the headquarters of Pholo Modi Wa Sechaba, a community organization where she is part of a support group for people living with HIV/AIDS in her village of Welgavel.
Pholo Modi Wa Sechaba helped get Mogale out of bed and back on her feet. The organization sent a home-based care worker to nurse her, help her get to the hospital for treatment, teach her how to take her antiretroviral medication and manage her diet, and file for a government support grant—a source of money for disabled people.
Pholo Modi Wa Sechaba—meaning "health is the root of the nation" in Setswana, the local language—has about 21 caregivers serving 240 patients in four villages. They ensure that patients are taking their medication; they cook and clean, and disinfect and dress wounds from the many infections that bedevil those with an immune system compromised by HIV. In some cases they deliver food parcels to help families survive.
Pholo Modi Wa Sechaba is just one of thousands of local community based organizations helping the roughly 5.5 million people living with HIV/AIDS in South Africa. They are on the front line of the struggle, and play an essential role in providing services. "Community-based organizations are key in the fight against HIV/AIDS," says Gerard Payne the affiliate coordinator at the AIDS Consortium, an umbrella organization for the thousands of such community groups around South Africa. "Without them the fight against HIV and AIDS is a mere media campaign. They provide essential services in the community, they speak the language, and they understand the cultural issues in the communities."
Oxfam America is working with the AIDS Consortium to provide training and other support to community based organizations like Pholo Modi Wa Sechaba in South Africa's North West Province, one of the poorest areas of the country, with a high incidence of HIV/AIDS. The AIDS Consortium is working with 47 local community based organizations in the North West, and with funding from Oxfam it can expand its efforts to some of the 150 others struggling against HIV/AIDS in the province.
Pholo Mode Wa Sechaba helps patients get tested for HIV and, when patients test positive, counsels them on their treatment options and on how to "live positively." In addition to its home-based care program, it has a daycare for young children and an after-school program for orphans and others who need a place to do their homework and learn valuable life skills including how to prevent HIV.
Learning that you are HIV positive forces you to think about everything differently. Just having to share your status with your family is enough of a crisis for many newly diagnosed people. They then must struggle with how to live with what may at first seem a death sentence, how to make ends meet if they are too ill to work, how to endure the side effects of the medication, and how to manage the stigma of being HIV positive.
South Africa's health care system, while free, is overburdened and does not provide adequate social support for people living with HIV/AIDS. They can be tested, learn the result, and get a CD4 count (a measure of the blood cells that support their immune system). Many get free antiretroviral medication. But then they are really on their own—and if they lack a support system of family and friends, as many do in communities already ravaged by the disease, these patients are in crisis.
Pholo Modi Wa Sechaba helped Maria Mogale with these struggles, and helped her understand her treatment options. These are the most important lessons the organization teaches people in the community, particularly valuable to women who are sometimes excluded from health care options owing to poverty and discrimination—a violation of their right to health care. Family members may insist on traditional medicine, which frequently delays treatment, and can often hasten death.
Mogale learned this from Pholo Modi Wa Sechaba: "If people are sick, they need to go to the hospital, and not just stay at home and say they are bewitched," she says at her home, a three-room house made of metal sheets outside Welgavel. "I tell people, 'AIDS is there, but you can get better.'" She smiles as she speaks.
Mogale is a strong, positive example for members of her community—and this strength, tragically, is also a good example within her own family. Her daughter Portia, 18, learned she was HIV positive two months ago, and her 60-year-old mother Priscilla, who lives nearby, is also in treatment. Both are now thinking about their lives differently as well, and look to Mogale for advice on how to live and think about their future. Portia is in her second to last year of high school and is considering higher education, even as she is still learning what it means to be HIV positive.
For Maria Mogale, her future may involve helping others on a more formal basis: she wants to work with Pholo Modi Wa Sechaba. "I want to become a caregiver, and teach others what I have learned."
]]>Once rich and fertile and capable of producing bountiful crops, the soil is now bone dry. Without water, the community's crops and gardens won't grow. Without these vital fruits, vegetables and grains, people aren't able to get the nutritious foods they need to stay healthy. And in a community affected by HIV and AIDS, this has devastating consequences.
"The ground used to be soft and easy to dig by hand; water was freely available just under the surface and food was plentiful; there was a lake nearby that provided fish for us to eat," Thandi says. "But now the land is dry and hard and there is no water under the surface; even the lake has dried up."
Thandi says rainfall has become more erratic over the last few decades, occurring less frequently and for shorter periods. Other members of the community concur. The seasons are not the same as they used to be; winter is not as cold now and summer rains are more erratic. People here have experienced droughts and floods for as long as they can remember, but since the mid-1990s they have noticed a gradual drying of the land. Even the rainwater tanks that were installed as a solution to the problem now stand dry.
Although Hluhluwe's people know the climate is changing, they have not heard about global warming, nor do they have any knowledge about the current global debates on these issues.
For the men and women of Hluhluwe, one thing is clear?they desperately want to learn how to adapt to the changes in climate in the longer term. At the moment they are simply trying deal with the prolonged drought conditions as best they can, by doing what they have always done but on a reduced scale. They make their gardens smaller, grow different types of crops and walk further to collect water?but these are short-term coping mechanisms, not long-term solutions.
If current trends continue, the Intergovernmental Panel on Climate Change says, sub-Saharan Africa will be 2-4 degrees warmer by 2050, and have 10 percent less rainfall. There will be more extreme events such as drought and floods and the length of the growing season will shorten even further.
"We need water pipes," Thandi says. "We need to learn how to look after the land and adapt to the drier conditions; we need to grow more drought-tolerant crops and vegetables. We need to learn more about climate change, and we need training in how we can speak up on these issues."
]]>Like many elderly and retired people, 70-year-old Mapatsi Tsuro spends his days in the garden tending to his crop of vegetables. But for Tsuro this is no leisurely pastime, rather it is a matter of survival. When he should be enjoying his golden years with the support of the family he raised, he now has to feed and care for eight grandchildren, following the untimely deaths of his three children.
Tsuro lives in Chicomba in eastern Zimbabwe, but his plight is common to millions of rural families in the region with the world's highest HIV infection rate and the greatest number of AIDS-related deaths. In Zimbabwe 1.7 million of the population of 13-million are infected with HIV/AIDS and Almost 900,000 of those infected are women.
Behind the alarming statistics lies human tragedy. The hardship for those infected and their families begins long before they die. Stigma, fear and despair often follow a HIV-positive diagnosis. The loss of income and support when a breadwinner or caregiver becomes ill, and the diversion of household resources to provide care increases the burden on family members, particularly children caring for terminally ill parents. Many only leave behind the trauma of bereavement and orphans.
Almost one in four children in Zimbabwe, 1.1 million, are now orphaned by AIDS. This number continues to grow as HIV and AIDS dramatically increases the vulnerability of children. The majority of the country's orphans are absorbed by the elderly in rural Zimbabwean households, a group which is barely coping with the extreme economic and social conditions in the country.
Oxfam America is supporting the Single Parents Widows Support Network (SPWSN) to improve the security of vulnerable groups by providing for their immediate nutritional needs, building sustainable livelihoods and enhancing the resilience of communities. Since 2002 Oxfam has been responding to the ongoing food security crisis in Zimbabwe through a livelihoods support program in the Seke, Mudzi, and Chikomba districts of Mashonaland East Province. The program provides seeds, fertilizers, primary health kits and on-going support to some 10,000 vulnerable households.
The supply of summer grain and legume seeds ensures that communities are able to sustain food production and build seed reserves. Over 60 community and individual nutritional gardens have also been established to grow vegetable during the winter months. The gardens ensure sufficient household food and the nutrition vital for maintaining health. Surplus crops provide some income for immediate needs such as health and education. The vulnerable groups receiving support include women-headed households, child-headed households, and households caring for orphans and the chronically ill, especially those affected by HIV/AIDS.
Neighboring South Africa is the site of the world's highest HIV infections, but also the country with the most people on ARV treatment. The National Strategic Plan aims to extend treatment to 80% of those with Aids by 2011. The plan also recognizes that Community Based Organizations (CBOs) and Non Governmental Organizations (NGOs) form an essential part of the integrated approach needed to address HIV/AIDS issues at community level.
Oxfam America's partner, The AIDS Consortium (AC) is one of the largest umbrella organizations in South Africa with a network of over 1000 affiliates. Members include CBOs and individuals motivated to meet the needs of the communities they live in. They offer a wide variety of services ranging from support groups for people living with aids (PLWA), job creation projects, home-based care (HBC), feeding schemes and orphan support, to national advocacy campaigns and large-scale treatment services.
"Community-based care workers are the unsung hero's of our country in the fight against AIDS and for community development," says AC executive director Denise Hunt, "with very limited resources they are forging ahead and making a huge contribution on the ground."
The AIDS Consortium represents the NGO sector on the South African National AIDS Council (SANAC). Here it is working with government and the private sector to formalize and increase the role of civil society. Hunt believes, "The only way we are going to meet the access to treatment targets are through dramatic shifts in how health care is delivered. Community care workers are in a position to play an expanded role and we are pressing SANAC to secure the finances, training and resources which will enable them enhance to their skills and contribution to service delivery."
Dr Liz Floyd, the head of Gauteng Multisectoral AIDS Unit, agrees that a more significant role for organizations is needed to meet the increasing demand for HBC and other support services.
"Government is developing a decentralized strategy for health care. It is very important to spread the resources to a network of mass-based care workers on the ground in communities in order to build community capacity to respond to and reach the people who need it," says Dr Floyd.
AC founder and Patron, Supreme Court Judge Edwin Cameron, is one of the few public figures to have openly declared his sexual orientation and positive HIV status. He points out that the epidemic is likely to be around for a long time and that community groups are vital to ensure an adequate response for PLWA. "We don't have a cure, but we do have manageable treatment," says Judge Cameron. "The public sector program is good but it is not reaching enough people. Community-based workers can bridge the gap between where we are now and where we need to be."
]]>"This is not a typical campaign,” said Janet McKinley, chair of Oxfam America’s board of directors and of the Campaign for Oxfam America. “We're not raising money for new buildings or for a perpetual endowment. The highest return a donor can get is to put money to work now.”
“Oxfam is seeking investors who want to expand our programs over a five-year period, building the capacity of poor communities, particularly women, to earn more, save more, invest in their families, and better manage their risks,” McKinley continued. “And given the increasing frequency and severity of natural disasters, those risks are rising.” McKinley and her husband, George Miller, have already committed $5 million to the Campaign for Oxfam America.
“The show of support we have seen for the Campaign is especially significant since Oxfam, in order to preserve its independence and voice, does not accept funding from the US government. The organization depends entirely on gifts and grants from individual donors, foundations, and corporations to carry out its mission of poverty alleviation and social justice,” McKinley concluded.
To date, individuals have contributed 57 percent of the donations for the Campaign for Oxfam America. Foundations and corporations have donated 43 percent. The Campaign has received commitments for 10 seven-figure and 50 six-figure gifts.
Among the leading institutional donors, the New York City-based Ford Foundation has already committed $9 million to the Campaign.
“The foundation shares Oxfam America’s commitment to reducing poverty, creating economic opportunities, investing in women and families,” said Susan V. Berresford, president of the Ford Foundation. “We welcome these efforts to create lasting, equitable solutions to the most pressing global issues.”
Another major donor to Oxfam, The William and Flora Hewlett Foundation in Menlo Park, CA, has contributed $4.5 million in current grants.
“Oxfam makes canny use of its financial support,” said Paul Brest, president of the Hewlett Foundation. “We share its goals of reforming aid and making global trade practices fairer as an effective way to lift the world’s population out of poverty.”
Funds raised through the Campaign for Oxfam America will support longer-term investment in four distinct areas of work:
When Colombo University's Community Extension Center in Sri Lanka uncovered mistreatment of tsunami survivors, the researchers went straight to the country's Human Rights Commission to right the wrongs.
Anawim Trust researchers studying good practices among Indian non-governmental organizations (NGOs) in empowering women didn't settle for documenting what they saw: soon the NGOs were implementing new, more women-friendly policies in their organizations that reflected what they'd learned from the Trust.
And long before the Institute for Policy Studies had published its study on Sri Lanka's disaster management systems, researchers had already helped reshape the key national disaster agency.
This is research at its liveliest, where the findings get results before the ink is dry.
"The studies we're supporting aren't destined for a dusty shelf somewhere, and they're not carried out by academics from faraway places," says Russell Miles, an Oxfam humanitarian specialist. "We're partnering with local researchers who are dedicated to solving problems in their own countries."
The Oxfam program involves a process known as participatory action research. The "action" part of the name has to do with its purpose: getting immediate results, rather than studying issues simply for the sake of learning. And it's participatory in that focus groups and other interactive activities in the communities take precedence over Internet searches and leafing through books at the library.
"Reducing disaster risks is a complex process that requires continuous learning," says Miles. "We've found a way to ensure that community members are at the center of that learning process."
]]>Kristin, an Oxfam Global Ambassador, shared a platform with the President of Oxfam America, Raymond C. Offenheiser, and South African activists, to raise up the voices of the communities she has met, and to help ensure that they are given the dignity of effective HIV treatment and care.
This is Kristin’s second trip to South Africa, and she used her time to revisit the strong women and community groups that touched her in Soweto, as well as learning more about how HIV is tackled in South Africa from new groups in rural areas and informal settlements.
The trip helped Kristin appreciate the power and importance of community workers in South Africa’s response to the HIV and AIDS epidemic, as well as the obstacles that are preventing millions of people living with HIV from getting the treatment they need, such as the shortage of doctors, nurses and treatment clinics, particularly in rural areas.
Kristin Davis, Oxfam Global Ambassador, said:
“I have been amazed by the incredible strength and energy of South Africa’s community groups in tackling the AIDS epidemic in this country. People like Mama Grace, who runs a soup kitchen in Soweto for orphans and other vulnerable children, are an incredible tower of strength in South Africa’s uphill response to AIDS. These unsung heroes are pulling together what little food and money they have to provide care to those living with HIV. Oxfam helps support them in this effort. These people are inspirational, but can’t win the battle on their own. These communities need nurses and doctors. These wonderful people are holding up their communities and need our support.”
The AIDS epidemic is the leading cause of death in South Africa, with an estimated 400,000 people dying of HIV-related causes each year. To respond, the country has mounted the biggest rollout of HIV treatment in the world, which has seen over 300,000 people receiving anti-retrovirals on the public health system. However, many barriers to good health for people living with HIV remain. A shortage of doctors, nurses and clinics prevent people from getting the treatment they need – in one community Kristin visited the nearest clinic was over 80km away, which meant people had to take a day off work and pay R100 or more for a round trip on public transport to get the treatment they so desperately required.
Oxfam’s South African partners, the Treatment Action Campaign and the AIDS consortium both spoke at the press conference.
Denise Hunt from the AIDS Consortium called on the South African government to empower and harness the skills of community health care workers to help extend access to treatment to more people, more rapidly. She called for extra training for the community groups already providing care. With training, those providing home-based care for men, women and children living with HIV could play a larger role in rolling out treatment.
Community care worker, Sibongile Mazibuko-Mkwanazi, raised the importance of tackling stigma as a part of the HIV response saying that stigma prevents people, particularly women, from coming forward for testing. “We should never allow HIV to come between us as families and communities’” she said. “All of us, one on one, need to be united in the fight against AIDS”.
Oxfam recognises the important role of community organizations and continues to support innovative approaches to expanding access to treatment and care for people living with HIV in South Africa, as well as campaigning on the global level for more doctors, nurses, and community healthcare workers to boost the level of care and treatment received by millions of people living with HIV.
Raymond C. Offenheiser, President, Oxfam America, says:
"The AIDS epidemic does not respect race, class, gender or ethnicity. But lives can be saved through unique partnerships that support access to medicines, quality health services and empowered community leadership. Behind the statistics lies a preventable human tragedy that can and must be confronted."
Kristin Davis was on a four-day visit to South Africa from January 29 – February 2, 2008. Kristin’s visit continued her efforts to gain a better understanding of the HIV/AIDS situation in the country. Organizations she met include Let Us Grow in Orange Farm, Circle of Promise in Soweto and HIV and AIDS projects in the North West province.
]]>But lately that medicine has become harder to come by as pharmaceutical corporations have priced poor people out of the market. Five years after the World Trade Organization's members unanimously reaffirmed developing countries' rights to produce, export, and import affordable copies of patented drugs, rich country governments keep breaking their promises.
Countries like the US are forcing developing nations to accept free trade agreements that violate the spirit of the WTO's decision on medicine patents. The provisions contained in US-negotiated free trade agreements would restrict the availability of generic drugs; people who can't afford brand-name medicines for infectious diseases like HIV/AIDS or for chronic illnesses like diabetes or heart disease would have to go without.
This fall, Oxfam's partner, the Educational Network for Global and Grassroots Exchange, brought three Thai HIV/AIDS activists to New York, Washington DC, Pennsylvania, Texas, Illinois, Minnesota and California to speak out against the proposed US-Thailand Free Trade Agreement. The tour was part of Oxfam's campaign to change trade rules that favor rich countries over poor people and company profits over public health.
"Americans don't know much about the HIV/AIDS epidemic in Thailand or the negative impact that a US free trade agreement would have on the cheap drugs that the government makes," said Matthew Coghlan, Oxfam's Regional Trade Policy Officer in East Asia. "This tour gave the Thai speakers the chance to educate Americans about what's really at stake."
Boripat Donmon, or Pii Muu as he's known, has been living with HIV for 13 years. During that time, he has become an instrumental leader in the fight for greater access to HIV and AIDS medicines in Thailand. His organization, the Thai Network of People Living with HIV/AIDS, gathered 50,000 signatures from the Thai public to lobby the Thai government to revise its national health policies. With pressure from hundreds of other organizations mounting, the Thai government announced last year that it would include treatment for HIV and AIDS in the national health insurance plan, commonly known as the "30 Baht Scheme."
Since then, though, people like Pii Muu have been forced to stop treatment. As they become resistant to older drugs that are manufactured by the Thai government, they must take newer drugs still under patent to prolong their lives. But currently patent rules give brand-name companies exclusive rights to market their medicines for 20 years, which allows them to charge more than most sick Thais can afford.
"The situation will only worsen if the US-Thailand FTA is approved," Pii Muu said during a stop on the tour in New York City. US free trade agreements severely restrict the ability of developing countries to ensure availability of generic versions of patented medicines—the only proven way to lower prices. "Most Thais make $140 a month—way below what patented medicines cost," he continued. "I don't know how anyone will be able to afford them with an FTA."
Sang-Siri Teemanka, also known as Pii Tui, agreed. An organizer with Thailand's Aids Access Foundation, she has also spent much of her career campaigning to get the Thai national health system to offer affordable anti-retroviral medicines.
"The problem now in Thailand is that the basic treatment manufactured ... at the cheap price will become ineffective for some patients after just three to five years. They will need to change medicines, and the new drugs are patented by the giant foreign pharmaceutical companies," Pii Tui said. "These drugs are very expensive."
Negotiations for a free trade agreement with the US are a contentious issue in Thailand. In January 2006, thousands of people took to the streets in Chiang Mai, Thailand to protest their lack of involvement.
The Thai activists touring the US said they want their government to recognize the people's rights to shape the trade rules that would have real effects on their daily lives. Specifically, the Thai activists asked that the government educate the people about the US-Thailand FTA, consult with them when negotiating it, and invite them to participate in decision-making.
They also asked that Americans lobby the US government and the WTO to help poorer countries like Thailand assert their right to make available generic versions of the patented drugs.
"We want the US to understand that the FTA is not balanced," Pii Tui said. "Access to medicine is very important to Thailand. It is not like CDs or computer software. People's lives are at stake."
]]>The 25th anniversary of the AIDS epidemic has come and gone, and after all the UN meetings, the hand wringing, and the finger pointing, there remains one key element that has received little press: In the epicenter of the AIDS epidemic—in southern Africa, home to one of every three people in the world living with HIV—it is women like Leona, in Mozambique, who are shouldering a disproportionate burden of the disease.
The problem here is lack of respect for women's rights. In some places in southern Africa women are prohibited by law from owning or inheriting property, and so have few financial assets. This limits their independence, putting them at risk financially, emotionally, and sexually. It is not surprising that more than half of the world's HIV-infected women, more than nine million of them, live in southern Africa, according to the UNAIDS report released in November 2006. With little power to negotiate their sexual activity, females in some areas of southern Africa now represent three quarters of HIV and AIDS infected people aged 15 to 24. When people say AIDS has become a "feminized" epidemic, this is what they mean. In 2004, UN Secretary General Kofi Annan appointed a task force to study the problem. The experts urgently recommended the development of non-discriminatory laws and policies designed to help women protect their rights and reduce their vulnerability.
The countries of southern Africa lack adequate resources (not to mention a vaccine and access to drugs) to care for the millions with HIV and AIDS. Yet unlike the scientific barriers to ending the epidemic, it is well within our power to support women's rights—an essential means to cutting down the number of women infected and affected by HIV and AIDS.
Creating equal rights for women in Africa, like everywhere else, is a challenge. Last May, I saw it for myself. Within an hour of my arrival in South Africa, I heard on the radio that the African National Congress's Deputy President Jacob Zuma was acquitted of charges that he had raped an HIV-positive woman, the daughter of an ANC comrade.
Violence against women is endemic in South Africa, where a woman is raped every 26 seconds. But women's rights experts I met said that the Zuma trial itself said a lot about the country's attitude toward women. There was intense scrutiny of the victim's sexual past, while Zuma's was not considered. Zuma, a potential presidential candidate, arrived at the courthouse in a motorcade with body guards and enjoyed vocal supporters in the streets as he proudly invoked his Zulu culture to explain why he'd had unprotected sex with the woman. By contrast, attempting to ensure her safety and preserve her privacy, the accuser crept into the court through the back door. The discrepancy in power and access to justice was remarkable, especially since the country was just celebrating the 10th anniversary of its progressive constitution, which has very clear provisions guaranteeing equality for men and women before the law.
But for every Zuma trial, there is progress too. The day I encountered Leona in Mozambique, she met with a legal advisor at a women's rights organization in Maputo to learn how to defend her right to stay in her house. Accustomed to claiming a dead relative's assets, her in-laws did not realize that Mozambique had a new Family Law that protects the right of widows to inherit property. "He never had another wife," Leona said, "so no matter what his relatives say, I have the right to inherit the house and things."
In addition to changing laws, proponents of women's right also need to work with cultural leaders to help encourage long-term changes in customs and traditions that discriminate against women. Women themselves are taking this on, sometimes at great personal risk. Cecilia Reis, an elderly traditional healer and guardian of culture and tradition in her community, told me that she is committed to teaching women about their rights under Mozambique's new Family Law to counter the exploitative customs that put them in danger of poverty and abuse. "You have to stand up, face men eye to eye," she told me. "This is the only way for them to see the power of women."
In one of the most notable successes of legal reform in the region, a coalition of five women rights and development organizations in Mozambique, funded by Oxfam America, researched and advocated forthe new Family Law. They showed what strong organizations and committed women can do with the right kind of assistance.
Governments, the UN, international NGOs, and other donors need to expand their horizons in the fight against HIV and AIDS, and address the gender dimension of the crisis. We all have a responsibility to ensure that women like Cecilia have the support they need to create solutions to their own problems. For the most heavily infected and affected part of the world, it is an essential component in the fight against AIDS and the fight for our future.
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