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."
]]>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."
]]>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.
]]>Women who are beaten by a husband or partner, or are emotionally or financially dominated, are much more likely to be infected than those living in a non-violent household. Abused women have limited abilities to negotiate their sexual activity or safe sex practices, and are vulnerable to even more abuse if they are the first to learn of their infection status and have to tell their partners.
Any effort to bring down HIV infection rates also needs to reduce violence against women—and women need to take the lead in pushing governments to deal with the problem. However there is little pressure to provide better protection for women. Social norms in southern Africa (and many other parts of the world), discourage women from speaking out about such "private matters."
In southern Africa, this silence is proving deadly. "Organizations of people affected by AIDS are weak," said Mark Heywood, head of the AIDS Law Project at the University of Witwatersrand in South Africa. "Women are centrally affected, but the response is limited to services to orphans and other areas," he said.
The gender violence situation is particularly serious in South Africa, a country of 47 million people where more than 5 million are living with HIV and AIDS. A woman is raped every 26 minutes, and a woman is killed every six hours. More than three quarters of young South Africans living with HIV are females, and more than one quarter say their first sexual experience was unwanted, says a report by the Medical Research Council in South Africa.
Since the end of apartheid, some new and progressive laws have been passed to reduce violence against women, such as the 1998 Domestic Violence Act. But that law is not being enforced, and there is no strong effort to force society to address the problem and to empower women to speak out about gender violence. This would help move the problem out from the shadows of their private lives and into the public realm, where the government must acknowledge violence against women for what it is: a serious human rights issue with significant social and economic implications for fighting poverty.
As a first step in helping organize the critical mass needed to oppose gender violence in South Africa and across the region, Oxfam America is funding the Johannesburg-based People Opposed to Women's Abuse (POWA) organization's work to document all the groups providing services to abused women, as well as those engaged in advocacy and public information campaigns on women's rights.
All across South Africa, small, community-based organizations help women victims of domestic violence. They provide safe housing, counseling, legal and medical assistance, and other services. But there is no strong, political effort to deal with violence against women. Women's organizations are not linked to speak with one voice about the problems of domestic violence and push for legal reforms and changes in policies and traditions that will protect women. This means they are treating the symptoms, but not the root causes of the problem.
"We need to maintain the service delivery, but we feel we need to stop reacting and help these community-based organizations speak out as well," explained Delphine Serumaga, Director of POWA. "We need to push from underneath."
Oxfam partners in southern Africa are also participating in the global "16 Days of Activism Against Gender Violence." The Center for Global Women's Leadership at Rutgers University in New Jersey is organizing the campaign, which starts on November 25th, the International Day Against Violence Against Women, and ends on December 10th, International Human Rights Day. The campaign also coincides with International AIDS Day in December 1st. This year's theme for the 16 Days campaign is "For the Health of Women, for the Health of the World." It is designed to highlight the connections between violence against women and the HIV/AIDS pandemic, as well as the unmet commitments made by governments to deal with the HIV/AIDS crisis.
South Africa: POWA is working with Amnesty International South Africa to host an international "cyber-dialogue" on the subject of trafficking of women and violence against refugee women in southern Africa. This public information campaign is building on a Listserv set up by the 16 Days campaign to promote dialogue and organizing around violence against women. POWA hopes the electronic discussion will help activists in all the Southern Africa Development Community (SADC) countries build joint efforts to combat violence against women, another goal of Oxfam America's HIV/AIDS program in the region.
Interested participants in the 16 Days of Activism Against Gender Violence cyber-dialogue in southern Africa can visit www.genderlinks.org.za
Zimbabwe: The Women's Action Group (WAG), an Oxfam America partner since 2000 and a member of a coalition promoting new domestic violence legislation in Zimbabwe, is leading a campaign to educate women about their rights and HIV/AIDS. WAG is participating in a number of events marking the 16 Days campaign around the country. First will be the national launch of the campaign by the Zimbabwe Ministry of Women's Affairs, followed by events to raise awareness of child abuse, HIV and AIDS, and domestic violence in Macheke, where there have been recent reports of abuse at a primary school. WAG will also be working with the National AIDS Council to commemorate International AIDS Day on December 1st in Chiramanzu, and will then host a series of discussions on cultural practices that increase women's vulnerability to HIV/AIDS from December 2nd through the 9th in Marondera.
]]>His words were spoken at a gathering to mark the beginning of a new collaboration to expand efforts to improve the situation of women's rights as a precondition to overcome the deadly HIV/AIDS epidemic ravaging the sub-region. Oxfam America's Southern Africa program kicked off the new program area with a convening of key organizations in the region culminating in the press event on Constitution Hill.
The HIV/AIDS crisis is the most significant obstacle to development in southern Africa. Recent studies by UNAIDS and a special task force appointed by the UN Secretary General studying women, girls, and HIV/AIDS in southern Africa show some staggering statistics: 30 percent of the world's people living with HIV/AIDS (about 11.4 million) are in nine countries that contain only two percent of the entire earth's population. Women and girls are sharing a disproportionate burden of infection and death from the insidious disease. The task force study estimates that three quarters of the young people 15 to 24 years old in Zimbabwe, South Africa, and Zambia that are currently living with HIV/AIDS are young girls and women.
These reports acknowledge one key reason women and girls are so vulnerable: their legal rights are not respected. Unequal laws on divorce and inheritance, as well as weak domestic violence legislation are leaving women vulnerable to abuse and poverty in an insecure environment. In some cases, women are considered legal minors, and are not allowed to make important decisions about their own lives, even if their husbands die.
Infected women, and those simply affected by the crisis, are missing out on employment and education opportunities as they fall ill or have to care for sick family members. Societal tolerance of sexual violence and harmful traditions frequently prevent women from controlling their sexual activity and discourage legal recourse in abuse cases.
Beyond wasting the potential of women in southern Africa, the resulting social dislocation, heavy health care and burial costs, and shortened life spans from the HIV/AIDS epidemic threaten the future for an entire generation. "We have crossed the threshold between the potential impact on women's development," said Mark Heywood, Director of the Aids Law Project of South Africa, speaking at a two-day conference sponsored by Oxfam America. "We are clearly experiencing the epidemic's impact on women's rights, which is a crucial aspect of what HIV/AIDS is doing to society."
Oxfam America has concentrated resources in the area of legal reform in Zimbabwe and Mozambique over the last eight years. Grant funds have supported research, advocacy, and popular campaigns designed to improve the legal framework to support women's rights in family laws, land ownership, domestic violence, and other key areas that directly affect women's welfare and livelihoods.
The new program area titled "HIV/AIDS Policy, Law and Women's Rights Partnership Program" builds off of the legal reform work in ways designed to help reduce the vulnerability of women to the disease, and eventually eradicate it. "Oxfam America must have a strong HIV/AIDS program in southern Africa,"" explained Regional Director Julio de Sousa. "In concentrating on these essential human rights issues, we will further women's rights and contribute to the fight against the epidemic."
Staff in Oxfam America's office in southern Africa consulted with a wide range of organizations with expertise in the areas of women's rights and the HIV/AIDS crisis. Together they developed a program that will include grants to organizations working on strengthening laws and policies designed to promote respect for women's rights, and challenging the social norms and values that condone violence against women and girls and contribute to their lower social status. Of equal importance will be looking at ways to improve the social support services essential for assisting women, including law enforcement, access to health care, and counseling.
The expanded program focus is building on fruitful collaborations with women's rights coalitions in Zimbabwe, Mozambique, and constructing similar partnerships in South Africa and Namibia.
At the press event in Johannesburg, Justice Van Westhuizen challenged Oxfam America and its partners in this new program area to think big, to even dream. "We must be able to dream—because without dreams we will not exist." As one of the framers of South Africa's constitution, considered one of the world's most progressive, he was well aware of the power of a dream, as South Africa enters its 10th year under majority rule.
Equality for women and a stronger southern African society free of HIV/AIDS is still in the future, but the ideas are coming into place to make it a reality. As South Africa has shown, a dream is just the start of big things.
]]>AWC's greatest strength is its connection to local communities. Beneficiaries for food relief are selected based on vulnerability with priority given to the elderly, the chronically ill, widows, orphans, and child-headed households. Food is distributed in the presence of the community, and people are encouraged to speak up if they feel that there is a discrepancy or injustice in the allocation system.
Local women run the impartial, apolitical food distribution system. The organization is well established and has a good reputation, and the communities themselves are directly involved in the distribution process through their AWC members and representatives.
As of early March, the breakdown among the 13,200 beneficiary families was as follows:
Individual families receive 20 kg of maize per month or 50 kg when supplies are adequate. Household size is taken into account with larger households given greater amounts. Efforts are made to deliver in each area once a month.
The system is extraordinarily successful because it places a priority on transparency, ongoing community involvement, women's control of the distribution process, the "prohibition on politics" within AWC business, non-local AWC staff monitoring, and local leadership awareness and support of the distribution process.
Zimbabwe is facing a food shortage that will most likely continue until the next harvest season in April, 2004. AWC is expanding its relief program, adding additional rehabilitation measures such as bean distributions, water pumps, and micro finance programs.
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