Caring for MDR-TB patients at home or even at taking them to hospitals is a challenge for relatives, especially as the disease is uncertain to completely go away after treatment. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Jan 25 2015 (IPS)

About eight years ago, 44-year-old Tilda Chihota was struck with tuberculosis which kept her bed-ridden for over six months at her rural home in Zimbabwe’s Mwenezi district, 144 kilometres southwest of Masvingo, the country’s oldest town.

Although Chihota later recovered after receiving treatment at a local district hospital here, early this year, she was once again struck with the same ailment. This time is came with increased severity in the form of multi-drug-resistant tuberculosis (MDR-TB).“MDR-TB cases will continue to increase and worsen as long as the backlog of TB cases keeps increasing." -- Dr. Charles Sandy

MDR-TB occurs when a strain of TB bacteria becomes resistant to two or more “first-line” antibiotic drugs prescribed to combat standard TB.

According to the Ministry of Health and Child Welfare, cases of MDR-TB nearly doubled from 156 in 2011 to 244 cases in 2013. This was despite the fact that notifications for ordinary TB drastically declined from 47,000 in 2010 to 38,367 in 2012.

“I am HIV-positive, but because I defaulted on taking treatment drugs, doctors have diagnosed me with MDR-TB,” Chihota told IPS.

Cases of MDR-TB like Chihota’s are common among people who are living with HIV/AIDS, according to the United Nations AIDS organisation (UNAIDS). Close to 80 percent of TB patients in the care of Doctors Without Borders are co-infected with HIV/AIDS.

“The best way of avoiding MDR-TB is prevention through strict adherence to prescribed treatment by the health provider,” Dr. Charles Sandy, deputy director for the AIDS and TB unit in Zimbabwe’s Health ministry, told IPS.

According to the World Health Organisation (WHO), it takes longer to treat MDR-TB, which can only be cured with the use of very expensive second line drugs that often cause serious side effects.

These include nausea, vomiting and permanent deafness, which often deters patients from finishing their treatment course. On average, patients need to take between 12 and 15 tablets daily for two years, which cost about 5,000 dollars for the entire course.

“The treatment drugs required per each MDR-TB patient are quite expensive and involve the use of quantities of resources enough to treat more than 100 TB patients, which is a strain on government’s public health sector,” Everson Murwira, a local health inspector based in Gweru, a town 222 kilometres west of Harare, the Zimbabwean capital, told IPS.

Medical doctors also point out a litany of many other factors fuelling rising cases of MDR-TB here.

“Food insecurity, large numbers of Zimbabwe’s population living in destitution, lack of balanced diet and crowded and often poorly ventilated homes in both the countryside and high density suburbs in cities leads to TB patients not recovering, but rather further suffering from MDR-TB,” Tinashe Chauke, a private medical doctor often treating TB patients in Masvingo, told IPS.

Chauke added that because most Zimbabweans are poor, “they can hardly afford to visit doctors for regular medical check-ups, resulting in most former TB patients falling prey to MDR-TB.”

But government could be doing more to combat TB.

At last year’s World TB Day commemorations, Health Minister Dr. David Parirenyatwa expressed concern at the number of missed TB cases here, saying that based on WHO projections, Zimbabwe missed 30,000 TB cases in 2013 alone.

“We continue to miss TB cases because of stigma and lack of awareness in the community and limitations in access to health services as well as the quality of health services,” Dr. Parirenyatwa said at the time. World Tuberculosis Day falls on Mar. 24 each year.

Médecins Sans Frontières (MSF or Doctors without Borders in English) says direct observed treatment is the best model to manage MDR-TB.

“Direct observed treatment of MDR-TB patients in their homes by their loved ones is the best option, but in Zimbabwe, only doctors and nurses can inject patients and nobody else, which creates a challenge for patients,” an MSF medical doctor in Harare, speaking on the condition of anonymity, told IPS.

With the help of MSF two years ago, 3,200 patients in Zimbabwe were placed under treatment for TB while 63 patients were treated of MDR-TB.

Government cooperation with MSF, however, has been spotty. In a recent case, an MSF clinic in Beitbridge district near the South African border that treated HIV/AIDS and TB was forced to close after government officials accused the clinic of meddling in politics.

According to MSF, Zimbabwe trails behind other countries in Southern Africa in its response to TB. Diagnostics need improving and treatment needs to be decentralised to community levels, the health agency said in a recent report.

A 2010 UNICEF report revealed that 78 percent of Zimbabwe’s 13 million people were living in ‘absolute poverty’, following which the WHO global tuberculosis report of 2012 placed Zimbabwe’s estimated TB incidence per capita at 603 per 100,000 population.

“Besides inadequate medical facilities, there are also many cases where sick people have needlessly died because they could not access medical attention due to bad or nonexistent roads,” said Edmond Kabarapate, the village head of Kafurambanje Village, said in a recent press interview.

Although Zimbabwe has made significant strides in reducing HIV/AIDS infections to 15.6 percent from 16 percent in 2007, according to the United Nations Development Programme (UNDP), it is still a sad story for this country as it contends with the menace of MDR-TB.

“MDR-TB cases will continue to increase and worsen as long as the backlog of TB cases keeps increasing,” Dr. Sandy told IPS.

Evident of Dr Sandy’s sentiments, the 2009 WHO Global TB Control Report rated Zimbabwe as having the fourth highest incidence of TB in the world. In 2012, the WHO reported that the Southern African nation was amongst 22 countries referred to as the TB “high burden” countries.

Caught up in difficult health situations, especially MDR-TB, many Zimbabweans like Chihota are unsure whether or not they will live after contracting the disease.

“Whether for better or for worse, with the MDR-TB that is wasting me away, taking the complex treatment prescribed to me, I am still very uncertain about what the future holds in as far as my state of health and even my survival is concerned,” Chihota told IPS.

Edited by Lisa Vives

Many children under 15 in Zimbabwe discover their HIV status only when they fall critically ill later in life. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Jan 17 2015 (IPS)

Fifty-one-year-old Mateline Msipa is living with HIV. Her 17-year-old daughter, born after Msipa was diagnosed with the virus, may also have it, but she has never been tested.

“My daughter is not aware of my HIV status and with the stigma associated with the disease, it is hard for me to now open up to her about my status,” Msipa told IPS.“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents." -- 13-year-old Tracey Chihumwe

Msipa’s daughter says she has never attempted to undergo an HIV test despite Zimbabwe’s revised testing guidelines allowing children of her age to get one without parental consent.

“I have no reason to get tested for HIV because I have never engaged in sexual intercourse before,” the 17-year-old told IPS.

Figures show that thousands of children in Zimbabwe are infected with HIV – presenting a major battlefield for government efforts to defeat the spread of HIV /AIDS nationwide.

The U.N. agency UNAIDS estimates that nearly 200,000 children from birth to age 14 have the virus but are not in treatment because they have not been properly tested. It is a trend that researchers term “suboptimal” counseling and testing in that southern African country.

“Children often get tested for HIV [only] when they fall critically ill, which usually doesn’t save them from dying,” Letwin Zindove, an independent health expert who works as an HIV/AIDS counselor here, told IPS.

The new estimate threatens to dash the southern African nation’s effort to meet a U.N. goal of reversing the incidence of infection in the population by 2015.

Older children – between six and 15 – who might have acquired HIV at birth are especially vulnerable to a major outbreak of full-blown AIDS. A study last year by the London School of Hygiene and Tropical Medicine found this group received inadequate access to provider-initiated HIV testing and counselling by primary care-givers.

Lack of clear national standards for HIV/AIDS testing leads to confusion and missed diagnoses in some cases. Credit: Jeffrey Moyo/ IPS

The study found health-care workers were reluctant to offer testing which could expose the child to abuse if he or she tested positive. On top of this, long waiting periods for appointments also hindered routine testing and counseling.

Last year, Zimbabwe launched its revised national guidelines for HIV testing and counselling with special emphasis on couples, children and adolescents as it stepped up efforts to halt the spread of the virus ahead of the 2015 deadline of the U.N. Millennium Development Goals (MDGs).

Under these guidelines, a child aged 16 years or older is eligible to give full consent for HIV testing and counselling.

However, the study found that many healthcare workers don’t fully understand the new guidelines.

“They expressed confusion about the age at which a child could choose to test him/herself, what type of caregivers qualified as legal guardians, and whether guardians had to undergo testing themselves first,” it said.

The appearance of a slow-progressing HIV disease among children has also contributed to dangerous delays in testing. New research has found that a substantial number of HIV-infected children survive to older adulthood. Delaying testing and diagnosis until symptoms appear results in a high risk of chronic complications such as stunting and organ damage.

Under the U.N.’s MDG Target 6A, countries should have halted new infections and begun to reverse the spread of HIV/AIDS by 2015.

Zimbabwe’s numbers of HIV incidence may be high (14.7 percent of adults) but the numbers are higher yet in South Africa (17.8 percent), Botswana (23 percent), Lesotho (23.6 percent), and Swaziland 25.9 percent.

Countries with low numbers are Mali, Guinea, Burkina Faso, Benin, Sudan, Senegal, Niger, Mauritania and Somalia – ranging from 1.0 percent to 0.7 percent.

While most countries are achieving a measure of success towards the U.N. goal, two have been a major health care disappointment.

Uganda, once hailed as a Cinderella success story, and Chad have seen a rise in infections. It is a disappointing turnaround from the 1990s when an aggressive public awareness campaign that urged medical treatment and monogamous sexual relationships led to a precipitous drop in infection rates in Uganda.

In 2012, H.I.V. infection rates in Uganda were seen to have increased to 7.3 percent from 6.4 percent in 2005. Over roughly the same period, the United States, through its AIDS prevention strategy known as Pepfar, or the President’s Emergency Plan for AIDS Relief, spent 1.7 billion dollars in Uganda to fight AIDS.

Activists say children are not immune to the deep-rooted stigma surrounding HIV/AIDS here — another barrier to testing.

“Zimbabweans are one huge community, closely-knit, and once a child is tested for HIV, it becomes difficult for it to remain confidential, resulting in any child tested becoming exposed to stigma,” Sifiso Mhofu, an affiliate of the Zimbabwe National Network of People living with HIV, told IPS.

This problem is very real for orphans like 13-year-old Tracey Chihumwe (not her real name) from Mabvuku, a high-density suburb of Harare, the Zimbabwean capital.

“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents,” Chihumwe told IPS.

The Zimbabwean government is now struggling to ensure to that 85 percent of the population – including children and adolescents – knows their HIV status by the end of this year, in a desperate bid to meet the MDGs deadline in December.

But this will not be an easy task.

“Despite revised guidelines of HIV testing for children, pockets of resistance to get children tested for the virus exist from children themselves, parents and guardians as well,” a top government official, who requested to remain anonymous for professional reasons, told IPS.

Edited by Lisa Vives and Kitty Stapp

By Lyndal Rowlands and Mercedes Sayagues
UNITED NATIONS, Dec 29 2014 (IPS)

In rural Zambia and Malawi, new mums face long delays finding out if they have passed HIV on to their babies.

Without treatment, a third of babies born with HIV will die before their first birthday and half before their second. Starting treatment within the first 12 weeks of life vastly improves their chances of survival.

But testing babies is not easy in poor countries.

Because mothers pass antibodies to their babies in the womb, the usual adult antibody tests during the first months of life can be inaccurate.

A virological test is needed. But only a handful of central labs can do these in Zambia and Malawi. On the long journey to and from the lab on the back of a motorbike or truck, the blood sample or the result often gets lost.

Some studies suggest that nearly half of tests never reach the clinics or the mothers.

Meanwhile, the new mum returns to her village and she and the baby likely drop out from the clinic’s radar.

Malawi and Zambia each has an estimated one million people living with HIV. In 2012, new HIV infections among children numbered 9,400 in Zambia and 11,000 in Malawi. Just over one third of babies were tested.

The old system couldn’t cope. New ideas and technologies were needed.

Enter UNICEF Innovation with an open source, code-based RapidSMS software: as soon as the lab result is in, the rural clinic’s nurse receives it by SMS on a cell phone or looks it up on the website. In remote villages, a community health worker receives the SMS and alerts the parents.

All information is encoded to ensure privacy and the software includes a web dashboard for reporting and administration.

In Zambia, the turnaround was cut from two or three months down to one month, said Shadrack Omol, deputy representative of UNICEF in Lusaka.

The SMS relaying is part of an antenatal system, Project Mwana (KiSwahili for child), that brings other benefits for all new mums as well.

At the first antenatal visit, the mother’s details are entered in Mwana’s SMS reminder system for alerts on checkups, immunizations, baby weighing and drug refills.

Bundling the HIV component with regular mother and baby care helps avoid stigma and fear of being identified as HIV positive.

In 2011, a Mozambican charity with 22,000 people on ARV treatment tried to build a cellphone database to remind patients of appointments: fearing loss of privacy and stigma, only half gave their cellphone numbers.

In Zambia, Mwana covers 484 clinics in 10 provinces. In Malawi, it has delivered more than 20,000 tests.

The next step, says Emanuel Saka, HIV specialist with UNICEF in Malawi, will be “expanding the geographical coverage and scope of the technology” and targeting adolescents with HIV.

New solutions to old problems

The best solution would be to test babies at the point of care in the rural clinic without any delays. In Mozambique, health workers are trying out a new viral load testing machine that can diagnose young babies in less than one hour.

“This is a great breakthrough,” said Bindiya Meggi, a pharmacist working on this project with the National Institute of Health.

Made by the German company ALERE, the machine is being tried in four sites with the help of the Clinton Health Access Initiative.

“It’s very simple to use,” said Ocean Tobaiwa, a Zimbabwean technician at the trial clinic in Maputo

As the machine is tested, it is adapted to local conditions, such as irregular electricity, black outs, power surges, heat and humidity. German technicians visit regularly to tweak the machines.

At present, babies are tested at one-month of age. A dry blood sample is collected through a heel or finger prick and sent to a central lab for viral load analysis.

Mozambique has only four such labs for a population of 24 million, with some 900,000 HIV positive women, and thousands of kilometers of roads impassable in the rainy season.

Although in theory results should be returned in two weeks, the reality is one month or more. Meanwhile, as in Zambia and Malawi, mother and baby are lost to follow-up.

In Zambia, RapidSMS is the backbone of U-Report, a booming HIV hotline service for young people, which garnered 71,000 users in two years. (see sidebar)

UNICEF Innovation Labs work with universities and the public and private sector to find new solutions to old problems in health, education, and water and sanitation.

“There is so much to do in the area of technology and real time information that hasn’t yet been explored,” Kochi said.

Primary school children like the ones pictured here in Zimbabwe's capital Harare often drop out of school, casting doubts on this Southern African nation's capacity to achieve universal primary education for all by December 2015. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Dec 24 2014 (IPS)

Zimbabwe boasts of one of the highest rates of literacy across Africa but, but without free primary education, achieving universal primary education here may remain a pipe dream, educationists say.

It would also defeat Zimbabwe’s quest to reach the United Nations Millennium Development Goals (MDGs) by the deadline of 2015.

One of the MDGs requires countries the world over to achieve universal primary education by the end of 2015 and reintroduce free primary education. But more than 34 years after gaining independence from Britain, educationists say Zimbabwe is far from attaining universal primary education for all.

“Hordes of pupils enrolled in schools after independence at a time the Zimbabwean government made education free at primary school level,” Thabo Hlalo, a retired educationist from Zimbabwe’s Midlands Province, told IPS.“Without free primary education, school attendance has become intermittent, meaning that achieving universal primary education in line with the U.N. MDGs may remain imaginary for Zimbabwe” – Thabo Hlalo, retired educationist from Zimbabwe’s Midlands Province

”But now without free primary education, school attendance has become intermittent, meaning that achieving universal primary education in line with the U.N. MDGs may remain imaginary for Zimbabwe.”

At independence in 1980, the Zimbabwean government abolished all primary school tuition fees, but they have now crept in and crept up. Parents not only contend with fees that they cannot afford but also with expensive essentials like notebooks and uniforms.

Early this year, Zimbabwe reportedly approached the United Kingdom for funds to help cover fees for an estimated one million pupils who would otherwise be forced out of school. The cash-strapped government said it was unable to finance its Basic Education Assistance Module (BEAM), a scheme meant for poor children.

The U.K. government provided 10 million dollars from its Department for International Development but warned it may be the last contribution.

The school fees have been defended by Zimbabwe’s Education Minister Lazarus Dokora, who has gone on record as saying that parents who default on the fees should be taken to court.

Dokora’s “warning” comes despite the fact that at least 95 percent of Zimbabweans voted in a referendum in March last year to adopt a new Constitution expressly granting free primary education to all. Specifically, Section75 (1) (a) of the Zimbabwean Constitution provides for the right to state-funded basic education.

Despite this constitutional provision, it is still a sad story for many children like 9-year-old Tobias Chikota from Harare’s Caledonia informal settlement located about 30km south-east of Harare, the Zimbabwean capital.

“I dropped out of school early this year because my unemployed parents couldn’t afford to pay my school feels,” Chikota, who at the time was in Primary Four, told IPS.

While it is a requirement for nations to ensure a predictable and adequate state budget allocation to education under the MDGs, civil society activists here say the Zimbabwean government seems way off the mark in terms of prioritising education.

“Despite the impending deadline for the attainment of the MDGs, our government has not been and remains inconsistent in its budgetary structures in practically directing money towards education, which may make the attainment of universal primary education for all difficult, if not impossible, by 2015,” Catherine Mukwapati, a civil society activist and director of the Youth Dialogue Action Network, a democracy lobby group in Zimbabwe, told IPS.

Earlier this year, the Zimbabwean government allocated 919 million dollars to the country’s education sector in its 2015 national budget announcement, but for Mukwapati these were “mere void commitments made on paper, hardly followed by action as customary with our government.

Through UNICEF’s Education Transition Fund (ETF), the Zimbabwean government distributed 13 million textbooks to 5,575 schools countrywide in 2010, resulting in each pupil in primary schools countrywide receiving a set of four basic textbooks.

In spite of this gesture, a 2012 report by Zimbabwe’s Parliamentary Portfolio Committee on Education found that the country’s rural teachers are overwhelmed with work, operating at a ratio of one teacher to 60 pupils, far over the government-pegged teacher-pupil ratio of one to 40.

According to Save the Children, for over 3.2 million children enrolled in primary and secondary schools in Zimbabwe, there are only about 102,000 teachers.

A UNICEF report on the Status of Women’s and Children’s Rights in Zimbabwe released in 2012 says that at least 197,000 pupils drop out of primary schools each year, a situation that development experts here say hinders Zimbabwe from achieving universal primary education for all in line with the MDGs.

“School dropouts owing to lack of school fees, mostly at primary level, are peaking up annually and, therefore, talking about Zimbabwe achieving primary education for all by 2015 is a non-starter,” independent development expert Evans Dube told IPS.

And for many parents like 43-year-old Tambudzai Chihota, a widow whose six children are out of school due to non-payment of school fees, the promise of universal primary education means little.

“My children didn’t go beyond Grade [Primary] Five here because I had no money to pay their school fees and the universal primary education you talk about may not be my business as long as my children are still without access to further education,” Chihota told IPS.

The crisis facing the education system here has also been worsened by the flight of about 20,000 teachers from the country between 2007 and 2009 at the peak of Zimbabwe’s economic crisis.

Besides extremely low salaries, the Progressive Teachers’ Union of Zimbabwe (PTUZ), a teachers’ trade union organisation in Zimbabwe, says that morale is low among teachers, negatively affecting the quality of the country’s education.

An average teacher earns 400 dollars a month, well below the poverty datum line of 511 dollars a month for an average family of five in this Southern African nation.

“Universal education may be far from being achieved here by 2015 due to poor teachers’ salaries, causing a deterioration of the quality of education,” Raymond Majongwe, Secretary General of PTUZ, told IPS.

With just over 12 months left before the deadline for achievement of the MDGs, it appears unlikely that Zimbabwe will meet the target of universal primary education for all.

(Edited by Lisa Vives/Phil Harris)

By Davison Mudzingwa
JOHANNESBURG, Dec 23 2014 (IPS)

Lungile Thamela knows how he got infected with HIV: through his reckless choice to have unprotected sex with his partner although he knew she was living with HIV.

He wanted to prove his manhood by having a baby. Instead, he got HIV and was crushed by the burden of self-stigma.

Gendered concepts of masculinity influence how men behave around HIV and within antiretroviral treatment (ART) programs.

As a result, the number of men on ART in South Africa in 2012 was half the number of women.

Why are South African men reluctant to test for HIV, to start and stay on ART, and to join support groups?

Is it that health services are not men-friendly? Is it an idea of masculinity that mandates men to be stoic, to hide pain as a weakness and not to talk about their feelings?

What defines the relationship of men to health services and how can it be improved?

In this video by Davison Mudzingwa, experts and activists like Thamela, analyze the factors that drive men’s gendered vulnerability to HIV in South Africa and suggest ways to reduce it.

SILENT SUFFERING: MEN, MANHOOD AND HIV

By Mercedes Sayagues
Cape Town, Dec 18 2014 (IPS)

Across Africa, men have lower rates than women for HIV testing, antiretroviral treatment enrollment and adherence, viral load suppression and survival.

Generally, of all people on antiretroviral treatment (ART) in Africa, just over one-third are men.

The disparity can be even more dramatic: in South Africa, in 2012, half the number of men were taking the life-saving drugs compared to women: 1.3 million women and 651,000 men.

At the core of this inequality are socially constructed ideas of masculinity. To be a man means being strong, to ignore pain and symptoms. Hospitals are for women and children.

As a result, men test for HIV and start ART late, sometimes too late to beat the virus.

Manhood brings a mix of personal costs and benefits. Among the costs are men’s poor mental and physical health, and their difficulty to talk about their feelings.

It’s not considered macho to share personal problems. This is one reason why men hesitate to join support groups to help them cope with treatment.

Experts recommend setting up men-friendly clinics with opening hours suitable for working men, recruiting male champions to encourage men to join HIV support groups, and routine co-testing of couples at antenatal clinics.

HIV has become the leading cause of death among adolescents in Africa. Credit: Sam Olukoya/IPS

By Sam Olukoya
LAGOS, Nigeria, Dec 15 2014 (IPS)

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the No. 1 killer of adolescents.

Africa accounts for more than 80 per cent of the 2.1 million adolescents living with HIV globally.

Drivers of HIV infection among adolescents include scarce information about sexual reproductive health and HIV, unprotected sex and sexual violence.

Between 2005 and 2012 the global AIDS death toll fell by 30 percent but increased by 50 percent among adolescents, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Late HIV diagnosis, fear of discrimination, low enrolment and adherence to antiretroviral treatment, and absence of specialized health services for HIV positive youths are some of the factors responsible for AIDS related deaths among adolescents in Africa.

The 100th session of the ACP Council of Ministers, held in Brussels from Dec. 9 to 12, discussed prospects for a meaningful partnership with the European Union. Credit: Courtesy of ACP

By Valentina Gasbarri
BRUSSELS, Dec 12 2014 (IPS)

“There are still prospects for a meaningful ACP-EU partnership, capable of contributing and responding concretely and effectively to the objectives of promoting and attaining peace, security, poverty eradication and sustainable development,” according to the top official of the African, Caribbean and Pacific Group of States (ACP).

ACP Secretary General Alhaji Muhammad Mumuni was speaking at the 100th session of the ACP Council of Ministers held here from Dec. 9 to 12, during which ACP and European Union representatives took the opportunity to renew their commitment to working closely together, particularly in crafting a common strategy for the post-2015 global development agenda.

Besides discussing trade issues, development finance, humanitarian crises and the current Ebola crisis, the two sides also tackled future perspectives and challenges for the ACP itself and for its partnership with the European Union.“We must speed up our efforts. 2015 will not be the end of the road. The 2015-post development agenda presents us with the chance to go even further. We can play a role together. This is why the Joint ACP-EU Declaration on the Post-2015 Development Agenda … is so valuable” – European Development Commissioner Neven Mimica

It was agreed that comprehensive cooperation built on collaborative approaches, creative methods and innovative interventions in all the countries of the ACP will be the inspiration for a joint initiative in 2015, in the context of the celebration of the 40th anniversary of the Lomé Convention, the trade and aid agreement between the ACP and the European Community first signed in February 1075 in Lomé, Togo, and the forerunner to the Cotonou Agreement.

The European Union will also be celebrating European Year for Development in 2015, which is also the deadline year for the United Nations’ Millennium Development Goals (MDGs).

The convergence of these three events, and the anticipated adoption by the international community of the development framework which is to replace the MDGs, “together represent a unique opportunity for the ACP and the European Union to demonstrate in a concrete fashion that they have and continue to strive for impactful relations in the future,” said Bhoendratt Tewarie, Minister of Planning and Sustainable Development of Trinidad and Tobago, who chairs the ACP Ministerial Committee on Development Finance Cooperation.

While acknowledging the current economic and financial difficulties being experienced by the European Union and the efforts under way to address them, it was stressed that these do not undermine the validity and strength of the ACP-EU partnership, that the rationale behind the partnership remains valid and that efforts must be redoubled for mutual benefit.

Proof of the commitment to help ACP countries meet the objectives of the Cotonou Agreement was identified in the concrete efforts being undertaken by both sides to improve the quality of life of the most impoverished and vulnerable countries – as  well as other countries, including middle income and upper middle income countries – of the ACP which continue to experience serious developmental challenges.

European Commissioner for International Cooperation and Development Neven Mimica said that the post-2015 development agenda and the post-Cotonou framework – to succeed the current ACP-EC Partnership Agreement signed in Cotonou, Benin, in 2000 – “will shape development policy for the next decade.”

“We can agree on the need for an enhanced approach, building further on our partnership, incorporating overarching principles, such as respect for fundamental values, and taking account of specific realities in countries and regions,” he told the meeting.

The New EU Commission and EDF Programming

The Council of Ministers’ session was also the occasion for ACP members to meet with members of the new European Commission, which took office on Nov. 1, including the High Representative of the European Union for Foreign Affairs and Security Policy, Federica Mogherini, Development Commissioner Mimica as well as European Commissioner for Humanitarian Aid and Crisis Management, Christos Stylianides.

Under the new Commission, the eleventh edition of the European Union’s main instrument for providing development aid to ACP countries, the European Development Fund, has been approved for the period 2014-2020 fora total of 31.5 billion euro, but has not yet entered into force.

Pending a further six ratifications on the European side, which are expected by mid-2015, a “bridging facility” amounting to 1.5 billion euro sourced from unused funds from previous EDFs, will allow priority actions to continue in ACP countries in 2014 and 2015.

To date, 53 national indicative programmes (worth up to 10 billion euro for the period 2014-2020) have been signed, with the remaining programmes to be signed by early 2015.

At the regional level, there is broad agreement on the content – sectors and financial breakdown – of the programmes, which should be signed by the first semester of 2015. The Intra-ACP cooperation strategy will be also be adopted and signed during the first semester of 2015.

“But we must not be complacent,” said Mimica. “We must speed up our efforts. 2015 will not be the end of the road. The 2015-post development agenda presents us with the chance to go even further. We can play a role together. This is why the Joint ACP-EU Declaration on the Post-2015 Development Agenda, which was adopted last June in Nairobi, is so valuable.”

The Joint Declaration represents the springboard for building greater consensus and contributing towards meaningful and ambitious outcomes in July and September next year, looking forward to a post-Cotonou framework.

“Transforming the ACP Group into a Global Player”

Meanwhile, the ACP Group is currently reflecting on its institutional aspects, such as leadership, organizational mandate, and implementation of reforms which aim at making it a more effective and accountable stakeholder in the international political context, while working on reducing poverty and promoting sustainable development in member states.

Newly appointed ACP Secretary General, Ambassador Patrick Gomes from Guyana. Credit: Valentina Gasbarri/IPS

An Eminent Persons Group has been established and a report will be presented to the next ACP Summit with the aim of identifying the most suitable strategic approach for ACP to be more effective, more visible, more accountable in a world of partnership and ownership, incorporating overarching principles such as respect for fundamental values and taking into account the specificities of the realities in countries and regions.

An important sign of the ACP institutional change was also launched during the 100th Council of Ministers with the appointment of the new Secretary General, Patrick Gomes, who will head the ACP Secretariat from 2015 to 2020, a landmark period covering the latest part of the ACP partnership agreement with the European Union.

Appointment of the Secretary General generally follows a principle of rotation among the six ACP regions – West Africa (currently holding the post), East Africa, Central Africa, Southern Africa, the Caribbean and the Pacific Islands.

Gomes is the Ambassador of Guyana to the European Union and the Kingdom of Belgium and the country representative to the WTO, FAO, and the IFAD.

Gomes has led various high-level ambassadorial committees in the ACP system, currently serving as Chair of the Working Group on Future Perspectives of the ACP Group, which transmitted a final report on “Transforming the ACP Group into a Global Player” during the ACP Council of Ministers.

(Edited by Phil Harris)

Faced with starvation, hordes of jobless Zimbabweans in towns and cities here have turned to vending on streets pavements to put food on their tables. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Dec 9 2014 (IPS)

As unemployment deepens across this Southern African nation and as the country battles to achieve the United Nations Millennium Development Goals (MDGs) ahead of the December 2015 deadline, thousands of urban Zimbabweans here are facing starvation.

The MDGs are eight goals agreed to by all U.N. member states and all leading international development institutions to be achieved by the target date of 2015. These goals range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education.

Zimbabwe has a total population of just over 13 million people, according to the 2012 National Census – of these, 67 percent now live in rural areas while 33 percent live in urban areas.

According to the Poverty, Income, Consumption and Expenditure Survey report for 2011-2012 from the Zimbabwe Statistical Agency (ZIMSTAT), 30.4 percent of rural people in Zimbabwe are “extremely poor” – and are also people facing starvation – compared with 5.6 percent in urban areas.“The current inability of the economy to address people’s basic needs is leading to hunger in most urban households, with almost none of urban residents in Zimbabwe being able to afford three meals a day nowadays” – Philip Bohwasi, chairperson of Zimbabwe’s Council of Social Workers

Social workers find the stay of urban dwellers in Zimbabwe’s cities justifiable, but ridden with hardships.

“Remaining in towns and cities for many here is better than living in the countryside as every slightest job opportunity often starts in urban areas in spite of the expensive living conditions in towns and cities,” independent social worker Tracey Ngirazi told IPS.

According to Philip Bohwasi, chairperson of Zimbabwe’s Council of Social Workers, urban starvation is being caused by loss of jobs – the World Food Programme (WFP) estimates unemployment in Zimbabwe to be at 60 percent of the country’s total population.

“The current inability of the economy to address people’s basic needs is leading to hunger in most urban households, with almost none of urban residents in Zimbabwe affording three meals a day nowadays,” Bohwasi told IPS.

True to Bohwasi’s words, for many Zimbabwean urban residents like unemployed 39-year-old qualified accountant Josphat Madyira from the Zimbabwean capital Harare, starvation has become order of the day.

“Food stores are filled to the brim with groceries, but most of us here are jobless and therefore have no money to consistently buy very basic foodstuffs, resulting in us having mostly one meal per day,” Madyira told IPS.

Madyira lost his job at a local shoe manufacturing company after it shut down operations owing to the country’s deepening liquidity crunch, thanks to a failing economy here that has rendered millions of people jobless.

Asked how city dwellers like him are surviving, Madyira said: “People who are jobless like me have resorted to vending on streets pavements, selling anything we can lay our hands on as we battle to put food on our tables.”

The donor community, which often extends food aid to impoverished rural households, has rarely done the same in towns and cities here despite hunger now taking its toll on the urban population, according to civil society activists.

“Whether in cities or remote areas, hunger in Zimbabwe is equally ravaging ordinary people and most of the donor community has for long directed food aid to the countryside, rarely paying attention to towns and cities, which are also now succumbing to famine,” Catherine Mukwapati, director of the Youth Dialogue Action Network civil society organisation, told IPS.

Apparently failing to combat hunger in line with the MDGs, over the years Zimbabwe has not made great strides in eradicating extreme poverty and hunger due to the economic decline that has persisted since 2000.

As a result, earlier this year, the U.N. Children’s Fund (UNICEF), in partnership with the Zimbabwean government, extended its monthly cash pay-out scheme to urban areas.

Under this scheme, which started at the peak of Zimbabwe’s economic crisis in 2008, families living on less than 1.25 dollars a day receive a monthly pay-out of between 10 and 20 dollars, depending on the number of family members.

Economists and development experts here say that achieving the MDGs without food on people’s tables, especially in cities whose inhabitants are fast falling prey to growing hunger, is going to be a nightmare, if not highly impossible for Zimbabwe.

“Be it in cities or rural areas, Zimbabwe still has a lot of people living on less than 1.25 dollars a day, which is the global index measure of extreme poverty, a clear indication that as a country we are far from successfully combating hunger and poverty in line with the U.N. MDGs whose global deadline for world countries to achieve is next year,” independent development expert Obvious Sibanda told IPS.

According to the 2013 Human Development Index of the U.N. Development Programmer (UNDP), Zimbabwe is a low-income, food-deficit country, ranked 156 out of 187 countries globally and UNDP says that currently 72 percent of Zimbabweans live below the national poverty line.

Although hunger is now hammering people in both urban and rural areas, government sources also recognise that the pinch is being felt more by urban dwellers.

“The decline in formal employment, mostly in towns and cities, with many workers engaged in poorly remunerated informal jobs, has a direct bearing on both poverty and hunger, which is on a sharp rise in urban areas,” a top government economist, who declined to be named, admitted to IPS.

For the many hunger-stricken Madyiras in Zimbabwe’s towns and cities, meeting the MDGS by the end of next year matters little.

“Defeating starvation is far from me without decent and stable employment and whether or not my country fulfils the MDGs, it may be of no immediate result to many people like me,” Madyira told IPS.

(Edited by Phil Harris)

Young boy sitting on a wall outside 'Way Home', a UNICEF-assisted shelter providing food, accommodation, literacy trainings and HIV/AIDS-awareness lessons to street children in Odessa, Ukraine. Because of unsafe sex and injecting drug use, street adolescents are one of the groups most at risk of contracting HIV. Credit: UNICEF/G. Pirozzi

By Pavol Stracansky
KIEV, Dec 9 2014 (IPS)

Marginalised communities and civil society groups helping them are warning of a “tragedy” in Eastern Europe and Central Asia (EECA) as international funding for HIV/AIDS and tuberculosis (TB) programmes in the regions is cut back.

The EECA is home to the world’s only growing HIV/AIDS epidemic and is the single most-affected region by the spread of multi-drug resistant TB (MDR-TB). For years, HIV/AIDS and TB programmes in many of its countries have been heavily, or exclusively, reliant on funding from theGlobal Fund to Fight AIDS, TB and Malaria.

But this year has seen the Global Fund move to a new financing model based on national income statistics, under which funding in many EECA countries has already been – or will soon be – heavily cut.“This [reduction in Global Fund financing] could lead to tragedy because governments are not yet ready to take on the responsibility for addressing the HIV/AIDS epidemic. I would like decision-makers to understand that this is not just [about] epidemiological statistics but that our lives and health are at stake” – Viktoria Lintsova of the Eurasian Network of People Who Use Drugs (ENPUD)

Some of those likely to be most heavily affected by the cuts say that the reduction in Global Fund financing is putting essential HIV/AIDS and TB services, and with it lives, at risk.

Viktoria Lintsova of the Eurasian Network of People Who Use Drugs (ENPUD) told IPS: “This could lead to tragedy because governments are not yet ready to take on the responsibility for addressing the HIV/AIDS epidemic. I would like decision-makers to understand that this is not just [about] epidemiological statistics but that our lives and health are at stake.”

At the heart of their concerns are worries over funding for not just medical treatment for existing patients but prevention and other services for at risk and marginalised communities.

Injection drug use has been identified as the main driver of the HIV/AIDS epidemic in the EECA but HIV/AIDS is also being increasingly spread among men who have sex with men and sex workers – groups which are heavily marginalised because of political and societal attitudes to homosexuality and women.

TB, an equally severe health problem in the EECA, is closely linked to the HIV/AIDS epidemic because co-infection rates are often high.

Throughout the region, prevention and harm reduction services for marginalised groups are provided by civil society groups which rely almost exclusively on international funding.

Sveta McGill, health advocacy officer at international advocacy NGO Results UK, told IPS that the withdrawal of Global Fund funding could see many sick people slip under the health care radar.

She said: “It is affecting services provided by NGOs covering at-risk groups. These ‘low threshold entry’ services, while not necessarily medical interventions, are crucial to keep people from risk groups coming to centres where they get referred to medical institutions to get treatment and can access medical services as well.

“Often, they would not feel comfortable going straight to state health care institutions, and closing down these venues would mean that less people would be referred to state health care institutions.”

Critics point to rising HIV/AIDS infections in Romania in recent years as a sign of what could happen in other EECA countries when the Global Fund cuts back its financing.

The Global Fund ended financing for programmes in the country in 2010. According to data from the Romanian government, since then there has been a dramatic rise in HIV infections among people who use drugs: in 2013, about 30 percent of new HIV cases were linked to injection drug use compared with just three percent in 2010.

Under the Global Fund’s New Financing Model (NFM), the major change is a reduction in financing to middle income countries. Many EECA countries are now classified as middle income and critics say that while the organisation’s goal of looking to prioritise use of finite resources is sensible, national income data does not always accurately reflect the ability of people to access health care services, nor whether a country has the funds for an adequate disease response.

They point to studies showing disease burdens shifting from low income countries to middle income states, and poverty being greatest in middle income countries. Also, most people living with HIV live in middle income countries.

But some have also dismissed as naive the notion that, as the Global Fund wants, national governments will automatically fill the gap in funding left as the Global Fund cuts back its financing.

Many point to the situation in Ukraine as an example highlighting the problems of the NFM.

According to a report from the Open Society Foundations, Global Fund spending on HIV will drop by more than 50 percent for Ukraine between 2014 and 2015. This includes reductions in unit cost spending for people who use drugs by 37 percent, for sex workers by 24 percent and for men who have sex with men by 50 percent.

Meanwhile, the national HIV prevention budget was slashed by 71 percent in 2014 amid political and economic upheaval.

Lintsova, who lives in central Ukraine, told IPS of the problems drug users are currently facing.

She said that not only are there shortages of the right drugs to treat TB in some parts of the country, but that very few drug users have access to them. Places on opiate substitution treatment (OST) programmes are very limited and waiting times to join them long, sometimes fatally so.

“I know two people who died waiting to get on an OST programme,” she told IPS. “And there are other problems like a lack of needle exchange centres in rural areas, in fact a lack of any harm reduction services in small towns, which leads to high rates of HIV in those places.”

She added that without proper funding, the situation would not improve. “The only solution to these problems is financing,” she said.

But other stakeholders have also privately raised fears that a greater government role in fields such as drug procurement could see authorities looking to save money and procuring larger quantities of cheaper TB drugs of worse quality. Meanwhile, local legislation also makes procurement tenders long and difficult, leading, some health care experts predict, to governments running out of stocks of some essential medicines.

It is unclear how governments will deal with the reduction of Global Fund financing. The transition from Global Fund to domestic funding, although widely announced and anticipated, is not going smoothly in all countries.

Many are often unclear when the Global Fund will actually leave because no straightforward timing plan has been set. There are also specific problems in individual states. In Ukraine, in particular, domestic TB funding has been severely affected by the military conflict, struggling economy and currency fluctuation.

Late last month, these growing fears prompted 24 prominent NGOs in the region to send an open letter to the Global Fund warning of their ‘grave concerns’ over the allocation of funding in the region and calling for it to work with local groups and affected communities.

They specifically asked it to look at each country individually, rather than adopt a “one size fits all” approach.

The Global Fund declined to respond when contacted by IPS.

However, drug users who spoke to IPS said there was little hope of an improvement in the region’s HIV/AIDS and TB epidemics if the Global Fund fails to heed NGOs’ warnings.

Lintsova told IPS: “A lack of reaction to our calls could lead to problems accessing prevention and treatment programmes and a deepening of the EECA’s HIV/AIDS and TB epidemics.”

(Edited by Phil Harris)

A billboard in Freetown, Sierra Leone, urging people to go to hospital to be tested for HIV. Ebola has stopped people from doing that. Credit: Lansana Fofana/IPS

By Lansana Fofana
FREETOWN, Dec 1 2014 (IPS)

The outbreak of the deadly Ebola epidemic in Sierra Leone has dwarfed the campaign against HIV/AIDS, to the extent that patients no longer go to hospitals and treatment centres out of fear of contracting the Ebola virus.

“It is a big challenge for us. HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected,” Abubakar Koroma, Director of Communications at the National AIDS Secretariat, told IPS.“HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected” – Abubakar Koroma, Director of Communications, Sierra Leone’s National AIDS Secretariat

Sierra Leone records one of the lowest HIV/AIDS prevalence rates in the West African region. For over five years, the country has managed to stabilise the figures at 1.5 percent, out of a population of 6 million, mainly because of massive countrywide awareness raising. The authorities also offer free medicines and treatment to people living with HIV/AIDS.

But all this may be reversed if the Ebola crisis is not contained soon.

Before the outbreak of the Ebola crisis in Sierra Leone in April, one key area of success in the fight against HIV/AIDS had been in curtailing mother-to-child transmission. Today, however, there are concerns that it may surge again because pregnant women are now reluctant to go to hospitals for treatment.

In 2004, the prevalence rate among pregnant women was 4.9 percent but, just before the Ebola in April this year, the figure had dropped to 3.2 percent.

According to Koroma, “between January and now, that service [for pregnant women] has dropped by 80 percent. We are worried that the Ebola crisis may worsen the situation.” From the point of view of those already living with HIV/AIDS, this is already happening.

Idrissa Songo, Executive Director of the Network of HIV Positives in Sierra Leone (NETHIPS) advocacy group, says that its members fear going to hospitals for care and treatment and that they are constrained by what he described as a cut in the support they were receiving from donors and humanitarian organisations before the outbreak of Ebola.

“Donors and other philanthropists have turned their attention away from the fight against HIV/AIDS,” he said. “Now it’s all about Ebola. Most organisations have diverted their funding to the fight against Ebola and this is badly affecting our activities.”

Songo added that the core activities of NETHIPS, which include community awareness raising and training of members in care and prevention, have all come to a standstill because of the government’s ban on all public gatherings following the Ebola outbreak.

Given the current crisis, the National Aids Secretariat and the Ministry of Health have set up telephone hotlines to connect with people suffering from HIV/AIDS. The aim is to be able to trace and locate them and then get treatment to them. At the same time, HIV/AIDS patients are now receiving a quarterly supply of the drugs they need, compared with the monthly dosage they were receiving before Ebola struck.

According to Songo, these measures are working because “that way, our members, who fear going to hospitals and treatment centres, can stay at home and take their medication. We know it is risky to go to treatment centres nowadays because of the possibility of contracting Ebola, another killer disease,” Songo told IPS.

Notwithstanding the Ebola crisis, Ministry of Health officials say that they have not lost sight of the fight against HIV/AIDS.

Jonathan Abass Kamara, Public Relations Officer at the Ministry of Health, told IPS that attention is still focused on the fight against HIV/AIDS. “Even though Ebola has taken centre-stage, the Ministry is still very much focused on the fight against HIV/AIDS. We supply drugs to patients regularly and we try our best to give care and attention to them,” Kamara told IPS.

However, while Sierra Leone has made tremendous progress in the fight against HIV/AIDS and its success in this fight surpasses that of almost all countries in the West Africa region, it may well find it difficult to maintain its achievements in this sector if the Ebola epidemic is not brought under control.

(Edited by Phil Harris)

Gender inequalities drive the disproportionate rate of HIV infection among young South African women aged 15 to 24. Credit: Mercedes Sayagues/IPS

By Nqabomzi Bikitsha
JOHANNESBURG, Dec 1 2014 (IPS)

When she found out that she had human immunodeficiency virus (HIV), Thabisile Mkhize (not her real name) was scared.

She knew little about the virus that had been living in her body since birth and did not know whom to ask. Her mother had just died and she lived with her grandmother in rural KwaZulu Natal, where the HIV prevalence is the highest in South Africa, at 17 percent.

Today, at the age of 16,  Mkhize is an enthusiastic peer educator at her school,  discussing HIV prevention, safe sex and sexual rights. “I want young women to be safe, to make healthy sexual choices,“ she told IPS.South Africa has a perfect storm of early sexual debut, inter-generational sex, little HIV knowledge, violence, and gender and economic inequalities that lead young women aged between 15 and 24 to have a disproportionately high rate of HIV infection

South Africa has a perfect storm of early sexual debut, inter-generational sex, little HIV knowledge, violence, and gender and economic inequalities that lead young women aged between 15 and 24 to have a disproportionately high rate of HIV infection.

They account for one-quarter of new HIV infections and 14 percent of the country’s 6.4 million people living with HIV, according to the ‘South African National HIV Prevalence, Incidence and Behaviour Survey’.

Alarmingly, HIV incidence – the number of new  infections per year – among women aged between 15 and 24 is more than four times higher than among their male peers.

Professor Sinead Delany-Moretlwe, director for research at Wits Reproductive Health and HIV Institute (Wits RHI) in Johannesburg, describes the factors that put young women at higher risk.

“Structural drivers – gender, social and economic inequalities – interact in a number of ways and influence behaviour such as choice of sexual partner and condom use,” she said.

Explaining that young women find it difficult to protect themselves against HIV, she noted that they “end up with controlling partners and fail to negotiate condom use or are forced to have sex.”

Tumi Molebatse, a 20-year-old student from Soweto, is an example. Years ago she had an HIV test and would like to have another with her boyfriend of two years, or at least to have safe sex.  “But my boyfriend will think I am cheating on him if I ask for condoms,” she told IPS.  “He supports me financially so it’s better to not bring it up.”

In South Africa, one of the most unequal countries in the world, relationships with older men often pen the way for young women’s social mobility and material comfort.

According to Kerry Mangold from the South African National AIDS Council, inter-generational and transactional sex increase the risk of infection because older men have higher HIV rates than young men.

“It’s not rare to see a young girl sleep with an older man for food or a little bit of money,“ said Mkhize. “Young women aspire to have nice things in life but they don’t have money, they don’t have jobs, and they go for partners who can provide those things.”

According to the ‘South African National HIV Prevalence, Incidence and Behaviour Survey’, one-third of girls aged between 15 and 19 reported a partner five years or more their senior.

Risk and choices

“At its most extreme, gender inequality manifests as gender-based violence,” says Delany-Moretlwe.

In South Africa, young women who experienced intimate partner violence were 50 percent more likely to have acquired HIV than women who had not suffered violence, according to the UNAIDS Gap Report.

Despite decades of awareness campaigns, less than one-third of young women know how to prevent HIV.

Mkhize says that many girls hear about sex and HIV from friends and teachers, and often  the information is wrong. “I know girls who believe you cannot get HIV if you boyfriend has just come back from circumcision school and so they have sex without a condom,” she told IPS.

Mangold would like to see “an enabling environment for young women to make their own choices and reduce their risk.”

Since last year, the ZAZI initiative has been trying to do just that. A sassy campaign, ZAZI (from the Nguni words for “know yourself”) builds knowledge around sexual health through social media, video clips, poetry readings, street murals, music and fun activities that boost girls’ sense of self-worth.

“We hope to discourage them from opting for relationships with older men for material gain and give them confidence to negotiate condom use,” ZAZI advocacy manager Sara Chitambo told IPS.

ZAZI’s motto is “finding your inner strength”. On its website, girls can look up practical advice on what to do if they are raped, where to find contraception and how to prevent HIV.

(Edited by Mercedes Sayagues and Phil Harris)

As AIDS becomes the leading cause of death of adolescents in Africa, empowering youth – especially girls - to make safe life choices and avoid HIV is crucial. Credit: Mercedes Sayagues

By Sam Olukoya
LAGOS, Nigeria, Nov 21 2014 (IPS)

Two years ago, Shola* was kicked out of the family house in Abeokuta, in southwestern Nigeria, after testing HIV-positive at age 13. He was living with his father, his stepmother and their seven children.

“The stepmother insisted that Shola must go because he is likely to infect her children,” Tayo Akinpelu, programme director of Youth’s Future Savers Initiative, told IPS.

“Shola felt as an outcast,” says Akinpelu. Eventually, Shola’s grandparents took him in.

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the leading cause of death among adolescents.

“This is absolutely unacceptable,” says Craig McClure, chief of HIV programmes with the United Nations Children’s Fund (UNICEF), in New York. “What’s more, AIDS-related deaths are decreasing for all age groups except adolescents.”

The global AIDS death toll fell by 30 percent between 2005 and 2012 but increased by 50 percent among adolescents, says a UNICEF report.

Fear of seeking help

One reason for this shocking teen death toll, says Dr. Arjan de Wagt, chief of HIV/AIDS with UNICEF in Abuja, is the low number of adolescents on antiretroviral treatment (ART).

Of the 3.1 million Nigerians living with HIV, half are under 24 years. But only two out of ten HIV positive youth over 15 and just one out of ten under 15 received the lifesaving drugs in 2013, de Wagt told IPS.

Rejection by family and society, as happened to Shola, or fear of rejection, prevents adolescents from seeking help.

“Many HIV positive adolescents are dying in silence because they are too ashamed to access treatment,”’ Blessing Uju, a Lagos-based youth counsellor, told IPS.

“The shame is even bigger for the girls. In Nigeria, if you are HIV positive, the impression is that you are a commercial sex worker,” she says.

Sally* did not tell her parents or siblings when she tested HIV positive four years ago, at age 19.

“At the family level, there is a lot of stigma,” she told IPS.

Although aware of the danger of not taking her medication regularly, Sally often skipped it to avoid being seen with pills at home.

“As a young person, you need a confidant. If you are not strong, you might end up taking your life,” she says.

Teenagers need family help to stay on ART, says Akinpelu.

Shola’s grandparents would normally cook the first meal for the day in the afternoon until Akinpelu explained to them that the pills can cause nausea on an empty stomach and Shola needed a hearty meal earlier.

Uju says that treatment fatigue hits adolescents hard. “Some say they prefer to die than to continue taking their drugs,” she says.

High death toll

Of the 2.1 million adolescents living with HIV worldwide in 2012, more than 80 per cent are in sub-Saharan Africa, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Malawi, with 93,000 HIV positive teenagers, has 6,900 annual AIDS-related adolescent deaths.

The death toll is linked to late diagnosis and starting ART too late, explains Judith Sherman, of UNICEF in Lilongwe.

Malawi’s policy is that all children seen in health facilities should be offered an HIV test. “Unfortunately, this does not happen routinely,” she says.

Teenagers’ adherence to ART is lower than adults, says Sherman, “for a range of reasons like treatment fatigue, depression, fear of stigma, denial and unstable family relationships.”

Tanzania’s estimated 165,000 adolescents living with HIV face similar challenges as their peers in Nigeria and Malawi. (see sidebar)

Allison Jenkins, chief of HIV/AIDS with UNICEF in Tanzania, says that one effective way to help teenagers are clubs.

“Teen clubs improve adherence to treatment, especially among members who attend regularly,” she told IPS.

HIV among teen girls

Alarmingly, adolescent HIV prevalence is highly gendered, with teen girls showing infection rates that UNAIDS calls ”unacceptably high”.

Teen girls aged 15-19 in Mozambique have a prevalence of seven per cent, more than double the boys of the same age. Botswana presents a similar scenario.

Lucy Attah, of the Lagos-based Women and Children Living with HIV & AIDS, blames poverty.

“Girls have to trade sex for money to sustain themselves,” she says. “The pressure for money is higher in the cities where teenage girls compete to get the best mobile phones and clothes.”

Adolescents become sexually active, try drugs and alcohol, feel invulnerable, and experience the social and economic pressures of becoming an adult. HIV and the lack of youth-friendly health services compound the problem, says the UNICEF report.

 “We must do more and do it well, focusing on sub-Saharan Africa and on adolescent girls, where the heaviest burden lies,” says McClure.

*names changed to protect privacy

Edited by Mercedes Sayagues

Displaced women flee fighting by boat to Mingkaman, Awerial County, Lakes State, South Sudan.. Only one out of 10 HIV positive mothers can get the drugs needed to avoid infecting her baby. Credit: Mackenzie Knowles-Coursin/IPS

By Charlton Doki
JUBA, Nov 14 2014 (IPS)

Dressed in a flowered African print kitenge and a blue head scarf, Sabur Samson, 27, sits pensively at the HIV centre at Maridi Civil Hospital in South Sudan’s Western Equatoria state. 

Today she paid 20 South Sudanese pounds (about six dollars) for a bodaboda (motorbike taxi) ride to the centre and will have to skimp on food in the next days.

She will be hungry and few will help her in the village, although she is blind and a single mother of two children.

“Many people fear to come close because they fear they will contract HIV,” she told IPS.

Seated next to her, Khamis Mongo, 32, has lived with HIV for five years now and has suffered similar rejection. “Some people don’t want to eat from the same plate with me,” he says.

Mongo and Samson are among nearly 1,000 HIV positive people receiving care at the centre, of whom 250 are in antiretroviral therapy (ART). They are lucky: in South Sudan, just one out of 10 people needing ART gets it.

The clinic sees patients coming from as far as 100 kilometres.

“So many patients are dying because they can’t afford transport to collect their medicine here,” clinical officer Suzie Luka told IPS.

A one-way, 80 km bodaboda trip from Ibba to Maridi costs 150 South Sudanese pounds (47 dollars).

The challenges in Maridi are a microcosm of those that the world’s newest country, South Sudan, faces in containing the HIV epidemic.

Newly independent from north Sudan in 2011, and emerging from Africa’s longest civil war over 21 years with one of the world’s lowest human development statistics, South Sudan plunged again into fighting in December 2013.

The national HIV prevalence rate is under three percent and rising steadily, according to the Joint United Nations Programme for HIV/AIDS (UNAIDS).

This translates into 150,000 people living with HIV in a country whose social fabric and physical infrastructure was destroyed by successive wars.

 “Moving corpses”

Evelyn Letio, from the South Sudan Network of People Living with HIV, describes poor access, quality and continuity of health services, underpinned by denial of the disease and high stigma and discrimination, especially against women.

“Community leaders will hurriedly accept a divorce if it’s the woman who is positive and force her to leave the man’s house,” says Letio.”If it’s the man who is positive, they won’t allow the woman to leave the house so she can take care of him.”

Despite denial by government officials, discrimination is rampant within the civil service, she adds:  “People who have disclosed to be HIV positive are laid off and called ’moving corpses’.”

Inadequate financial, infrastructural and human resources limit efforts to expand HIV services.  The national HIV plan has an 80 percent funding shortfall.

Mongo and Sanson told IPS that the Maridi clinic often runs out of drugs and they have to return days later. Other times, staff has not been paid for months and stays away.

“Treatment has been tricky,” acknowledges Habib Daffalla Awongo, director general for programme coordination at South Sudan AIDS Commission.

According to UNAIDS, just 22 centres provided ART before the new outbreak of violence.

Last December, the ART centres in Bor, Malakal and Bentiu, capitals of the states worst hit by fighting, had to close. The whereabouts of 1,140 patients are unknown. Most likely they have interrupted ART, endangering their lives.

War and AIDS

Forty thousand people living with HIV have been directly affected by the recent violence, according to the United Nations. The new fighting reversed the gains made in HIV services since independence. 

“We have lost many HIV positive people during the conflict, some died in the fighting and others migrated to peaceful areas,” said Awongo.

By U.N. counts,  the new conflict has displaced 1.9 million people.

In Juba, the capital, camps with long rows of white tents have sprung up to shelter some 31,000 displaced people.

Among them is Taban Khamis*, who escaped fighting in the key oil city of Bentiu, 1,000 kms north of Juba. He has interrupted ART and fears his health will soon worsen but he will not go to the camp’s HV clinic for fear of stigma.

“The camp is crowded and there is no privacy,” he told IPS. “Everyone will know that I have HIV.”

Prevalence of HIV and sexually transmitted infections “dramatically increases in camps”, says a study by the HIV/AIDS Alliance.

Awongo is aware of this problem. “We encourage people to come out of the camps to facility points where they can access services but this is not making a difference,” he says.

*Name changed to protect his privacy

Edited by: Mercedes Sayagues

Gender inequalities explain why prevention is failing to contain HIV infection among young women in East and Southern Africa. UNAIDS calls for a major effort to reduce their risk of infection. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Nov 7 2014 (IPS)

Experts are raising alarm that years of HIV interventions throughout Africa have failed to stop infection among young women 15 to 24 years old.

“Prevention is failing for young women,” says Lillian Mworeko, HIV expert with International Community of Women Living with HIV in Eastern Africa, based in Uganda.

Among women in East and Southern Africa, four out of ten new HIV infections among women aged 15 years and over happen among  those aged 15 to 24, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Worryingly, HIV infection rates among young women are double or triple those of their male peers. In South Africa, the HIV prevalence of 18 percent among women aged 20-24 is three times higher than in men of the same age. 

Equally alarming are surveys showing that fewer than two in ten young women know their HIV status.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, limited access to health care, education and jobs, and health systems that do not address the needs of youth.

Biology does not help. Teenage girls’ immature genital tract is more prone to abrasions during sex, opening entry points for the virus, Dr Milly Muchai told IPS.

Muchai, a reproductive health expert in Kenya, says it is not just sex that drives HIV infections among young women but the age of the male sexual partner.

“The risk increases steadily with male partners aged 20 years and over,” she explains.

Older men are more likely to have HIV than teenage boys. The Kenya AIDS Indicator Survey 2012 shows that male HIV prevalence remains low and stable until the age of 24, when it shoots up significantly.

Due to intergenerational sex, women in this region are acquiring HIV five to seven years earlier than men, says Muchai, because these relationships are characterised by multiple sexual partners and low condom use. In transactional sex, the young woman receiving gifts or money loses power to negotiate safe sex.

But Kenya is not a unique scenario.

Shocking figures

In Swaziland, Lesotho and Botswana, more than one in 10 females aged 15 to 24 are living with HIV, according to UNAIDS.

Dr Gang Sun, UNAIDS country director in Botswana, says that, in spite of the country’s remarkable progress in reduction of new infections and treatment, HIV is still a girls’ and women’s epidemic due to gender inequality and unequal power dynamics.

Among Batswana youth aged 20 to 24 years, HIV infection among women triples that of men, nearly 15 percent compared to 5 percent, he says.

Mary Pat Kieffer, senior director at Elizabeth Glaser Paediatric AIDS Foundation in Malawi, told IPS that as teenage girls become older, the risk of infection rises.

In Swaziland, HIV prevalence is six percent for girls aged 15 to 17 but rises to a whopping 43 percent by age 24.

Source: UNICEF

A package of interventions

Kieffer says that many of the issues – poverty, lack of secondary education, few jobs, rape and intimate partner violence – that underpin the unacceptably high HIV prevalence among young women are bigger than what HIV programs alone can address.

Mworeko observes major gaps in reproductive and sexual health services for young people, when they are neither children nor adults, in the region.

“Whether it is prevention, treatment, care and support services, young people do not have a youth friendly corner,” she says.

Paska Kinuthia, youth officer with UNAIDS in South Africa, told IPS that sexuality education needs to be strengthened in schools across the region.

“The regional average of comprehensive knowledge of HIV and AIDS stands at 41 percent for young men and 33 percent for young women,” he says.

Experts agree there is no one single solution to protect young women and a combination of interventions is needed.

Addressing restrictive laws on the age of consent for HIV testing and for access to sexual and reproductive health services would be a good place to start, experts say.

Promoting gender equality and providing jobs for young people are part of the solution, says Sun.

In Tanzania, HIV infection among girls more than triples between 15-19 and 20-24 years.

This fact, says Allison Jenkins, chief of HIV/AIDS with the United Nations Children’s Fund in Dar es Salaam, underlines “the importance of orienting HIV prevention and economic livelihoods interventions during her transition to adulthood.”

For all these reasons, UNAIDS is calling for “a major movement to protect adolescent girls and young women from HIV infection.”

Edited by: Mercedes Sayagues

Every day, eleven Mozambican women die of cervical cancer. That is 4,000 every year. It is the most frequent cancer among women aged 15-44 and the biggest killer of women among all cancers. Credit: Mercedes Sayagues/IPS

By Mercedes Sayagues
MAPUTO, Oct 31 2014 (IPS)

Mozambique is reeling under the twin burden of HIV and cervical cancer. Eleven women die of cervical cancer every day, or 4,000 a year. Yet this cancer is preventable and treatable, if caught early.

Among African countries, Mozambique vies neck and neck with Malawi for the saddest statistics.

Mozambique has the highest cervical cancer cumulative risk and mortality – seven out of 100 newborn girls will develop this cancer and five will die from it.

Malawi is first in incidence (new cases per year), with Mozambique tailing second.

Cervical cancer is caused by the Human Papilloma Virus (HPV), a common virus with 40 types. Many people carry it dormant and often it goes away by itself. But two types of HPV cause cervical cancer.

HIV and HPV are deadly allies. HPV infection doubles the risk of acquiring HIV while HIV hastens progression of cervical cancer.

Some numbers will give an idea of Mozambique’s burden:

• 7.3 million women over age 15, who can potentially acquire HPV through sex.
• 820,000 women over age 15 living with HIV. Cervical cancer advances quickly with a weak immune system.
• 4,000 deaths of cervical cancer a year, not counting those who die at home, undiagnosed, untreated and unreported

Step by step, health authorities are tackling the problem with a three-pronged strategy: information for prevention, routine screening for detection, and better treatment.

There is even talk of bringing radio therapy equipment and training technicians. In terminal stages, radio therapy shrinks cancer and reducing excruciating pain.

Routine screening for this cancer is now offered with family planning services. Diagnosis and treatment via cryotherapy (freezing) can be done in one visit. The Ministry of Health hopes to cover all districts by 2017.

The mass media campaign had a tireless advocate in the former First Lady, Maria da Luz Guebuza. The Association for the Fight against Cancer, a volunteer group, has multiplied its outreach and helps patients at the oncology wards of main hospitals.

Information is dispelling the perception of cervical cancer as “the neighbour’s disease”, brought upon women by a neighbour’s curse or by witchcraft.

The situation is still dire; needs outpace resources, both human and financial. But it is a great improvement over just three years ago, when only a handful of clinics offered screening, and millions of women had never heard about HPV and cervical cancer at all.

Testing, treating and suppressing viral load in massive numbers could curb the spread of AIDS by 2020. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Oct 17 2014 (IPS)

Although AIDS has defied science by killing millions of people throughout Africa in the last three decades, HIV experts now believe that they have found the magic numbers to end AIDS as a public health threat in 15 years.

The magic numbers are 90-90-90 and are informed by growing clinical evidence showing that HIV treatment equals prevention because putting people on antiretroviral therapy (ART) reduces new infections.

The new treatment targets seek that, by 2020:

• 90 percent of people living with HIV get diagnosed
• 90 percent of people diagnosed with HIV will be on ART
• 90 percent of people on ART achieve durable viral suppression

The 90-90-90 plan, unveiled by the Joint United Nations Programme on HIV/AIDS (UNAIDS) earlier this year, seeks to halt the spread of HIV by 2020 and to end the epidemic by 2030.

While this is the most ambitious strategy to eliminate HIV yet, experts such as Dr Lucy Matu, director of technical services at the Elizabeth Glaser Paediatric AIDS Foundation in Kenya, says that it can be done.

She told IPS that in Kenya 72 percent of the estimated total number of people living with HIV have been tested, and 76 percent of the 880,000 adults and children diagnosed with HIV were on ART by April 2014.

Kenya will get closer to the 90-90-90 target as it implements the 2013 World Health Organisation (WHO) guidelines, which increased the CD4 count threshold to start ART from 350 to 500, says Matu.

As eligibility for ART becomes broader, she explains, “it will push the number of people on ART up by at least 250,000 to 300,000 to at least 90 percent of those in care, and of course more people will continue to enroll in care.”

An attainable goal

The WHO guidelines build on the clinical benefits of starting ART earlier. Patients stay healthier and avoid opportunistic infections, such as pneumonia, meningitis and TB.

Kenya is not the only country on track to achieving the ambitious 90-90-90 targets. In Botswana, which has a very high adult HIV prevalence, surpassed only by Swaziland globally, more than 70 percent of people living with HIV are on ART.

All East and Southern African countries are adopting the new guidelines, says Dr Eleanor Gouws-Williams, senior strategic information adviser with UNAIDS.

Rwanda, Uganda, Zambia, Malawi and Swaziland are “finalising their national guidelines while others like South Africa are planning to implement the new guidelines next year,” she told IPS.

Gouws-Williams believes that the 90-90-90 plan is attainable.

90-90-90: the formula that experts believe could write the final chapter on AIDS in 15 years. Courtesy: UNAIDS

Testing is the first step

Only half of all people living with HIV in sub-Saharan Africa have been diagnosed, says UNAIDS, so getting them to test is the first step.

Studies in Kenya and Uganda show that including HIV testing in multi-disease campaigns drove coverage up by 86 percent and 72 percent respectively.

But experts caution that the targets are more than putting loads of people on ART. Attaining viral suppression is key.

“In Rwanda, 83 percent of people receiving ART were found to be virally suppressed after 18 months of therapy,” says Gouws-Williams.

In Zimbabwe, Dr Agnes Mahomva, country director for the Elizabeth Glaser Paediatric AIDS Foundation, told IPS that 90-90-90 is not too ambitious for the Southern African country.

Already, she told IPS, “HIV positive pregnant and breast feeding mothers are universally eligible for ART for life as well as HIV positive children below five years, regardless of their CD4 count.”

While many experts are optimistic that 90-90-90 targets will be met, Ugandan HIV activist Annabel Nkunda says the targets do not necessarily speak to each other.

Nkunda told IPS that many HIV positive people, “when put on treatment, do not adhere to the treatment because of stigma.”

Without a specific target to reduce stigma, she says, “no amount of intervention will get us to zero HIV/AIDS.”

But some experts like Dr Matu disagree: “If you know your status, you are more likely to be put on HIV care. If you are on ART, you are more likely to stay within the health system for follow up.”

Finding funding

While it is still too early to estimate how much countries will spend to make 90-90-90 work, the consensus is that a lot of resources will be needed. Already, some African countries are exploring innovative financing options such as AIDS tax levies and national HIV trust funds.

Gouws-Williams points out that ART has become far more affordable. In Malawi, it costs less than 100 dollars per person per year.

Nonetheless, donor assistance will still be critical, especially for five poor countries where HIV treatment costs exceed five percent of gross domestic product (GDP) – Malawi, Lesotho, Zimbabwe, Mozambique and Burundi.

Matu says that achieving 90-90-90 requires a combination of factors, including a robust health system, good laboratory capabilities, cheaper viral load testing and a strong health work force.

Mahomva adds that a strong community component is needed, “because this is where several bottlenecks such as stigma happen, compromising adherence to HIV treatment.”

In spite of the uphill task ahead, many are optimistic that 90-90-90 will write the final chapter of the AIDS epidemic.

Edited by: Mercedes Sayagues

A nutritionist assesses the health of a child in the Sahel. Red indicates severe malnutrition. Credit: Kristin Palitza/IPS

By Noel Marie Zagre and Gary Quince
JOHANNESBURG, Sep 24 2014 (IPS)

Eric Turyasingura chases after a ball made from plastic bags outside his mud-brick home in the mountains of southern Uganda.

Yelling in his tribal tongue, Nkore, “Arsenal with the ball! Arsenal with the ball!” he jostles with his younger brothers for possession. 

The fame of the English soccer club has reached even his little ears. Pretending to be a sports star offers a moment of escape from his daily struggles.

At five years old, Eric’s tiny body already tells a story of poverty and lost opportunity. He is six inches shorter than he should be for his age. His arms and legs are pencil-thin and his head is out of proportion to his body.

Because he is stunted, experts say his chances growing up healthy, learning at full potential, and getting a job, let alone play professional soccer, have been greatly diminished.

In 2013, a United Nations Report said one in four children under five years, across the world – a total of 165 million – were stunted, while last year The Lancet estimated that undernutrition contributed 45 percent of all under-5 deaths.

Often beginning in the womb as poverty-stricken mothers live hand-to-mouth, stunting can be a lifelong affliction. Studies show it is linked to poor cognition and educational performance, low adult wages and lost productivity. A stunted child is nearly five times more likely to die from diarrhoea than a non-stunted child because of the physiological changes in a stunted body.

Development agencies say significant progress has been made in ensuring children are properly nourished, and as a result, the incidence of stunting is declining.

However, huge challenges remain and in sub-Saharan Africa, the proportion of stunted under-fives is two in five. With crises in South Sudan, the Central African Republic, Syria and now Iraq displacing millions of people, combating hunger and ensuring stunting rates don’t creep back up has become a top priority.

“We will not eliminate extreme poverty or achieve sustainable development without adequate food and nutrition for all,” said U.N. Secretary General Ban Ki Moon at a meeting of global hunger agencies in Rome.

“We cannot know peace or security if one in eight people are hungry.”

As such, the first “pillar” of Secretary General’s “Zero Hunger Challenge” aims to eliminate stunting in children under two years old.

The United Nations Children’s Fund (UNICEF) is also a partner in the Scaling Up Nutrition (SUN) Movement, another major global push, bringing together more than 50 countries in an effort put national policies in place and implement programme with shared nutrition goals.

One innovative programme – the Africa Nutrition Security Partnership, being implemented by UNICEF and funded by the European Union since 2011- is combating stunting both at the community level and the institution level.

Acutely malnourished children at risk of death are directed to health clinics, and at the same time health institutions and partners are given the tools they need to improve infant and young child feeding practices and hygiene, and better fight hunger and disease. The four-year programme focuses on Ethiopia (with a stunting rate of 44 percent), Uganda (33 percent), Mali (38 percent) and Burkina Faso (35 percent).

The aim is to change behaviour among households, set up systems for effective multisectoral approaches and increase government capacity, enabling these countries to battle against the effects of hunger long after the programme is complete.

In Uganda, for example, community workers have been provided with smart phones, programmed with information about hygiene, postnatal care and proper infant and maternal diet. The workers share the information with household members and then log their location on the smart phone’s GPS to prove they were there.

In Mali’s capital, Bamako, funding has been provided to broaden a master’s degree to provide advanced training to healthcare professionals about how to best design and implements nutrition programmes.

In Ethiopia, schoolgirls are being encouraged to delay marriage and pregnancy until they are at least 18, as a way of preventing intergenerational undernutrition. Older women are better able to carry a baby and rear children with stronger bodies and minds.

The increased focus on stunting by the humanitarian community is telling: its prevalence has become a kind of litmus test for the well being of children in general. A child who has grown to a normal height is more likely to live in a household where they wash their hands and have a toilet; is more likely to eat fruit and vegetables, is more likely to be going to school; is more likely to get a good job; and is less likely to die from disease.

Moreover, tipping the balance in favour of a child’s future isn’t as hard as some might think. The simple act of reinforcing the importance of exclusively breastfeeding a baby for the first six months of his or her life, for example, increases an infant’s chances of survival by six times.

Most of the regions where the partnership is being run have ample food to go around. It is other factors, such as failing to properly wash and dry utensils after meals, selling nutritious homegrown foods at market rather than eating them, and cultural sensitivities to things like vegetables and eggs that are causing problems. As such, simply education programmes can make a real difference and save countless lives.

The other challenge is ensuring there is enough political will to keep those programmes running. If the international community remains focused, the downward trend in stunting will continue. It could only be a few short years before children from modest African communities like the mountains of southern Uganda get to really play for teams like Arsenal. Children just need to be allowed to grow to their full potential and good things will follow.

Edited by: Nalisha Adams

Excerpt:

According to an African proverb, “every woman who gives birth has one foot on her grave.” Cameroonians are attempting to make this proverb a historical fact and not a present reality through SMS technology. Credit: Mercedes Sayagues/IPS

By Ngala Killian Chimtom
YAOUNDE, Sep 23 2014 (IPS)

“You can’t measure the joy in my heart,” Marceline Duba, from Lagdo in Cameroon’s Far North Region, tells IPS as she holds her grandson in her arms.  

“I am pretty sure we could have lost this child, and perhaps my daughter, if this medical doctor hadn’t shown up,” Duba says, a smile sweeping her face.

The medic in question is Dr Patrick Okwen. He is the coordinator of M-Health, a project sponsored by the United Nations Population Fund (UNFPA) that uses mobile technology to increase access to healthcare services to communities “when they most need it.”

The World Health Organisation (WHO) recommends that a nurse or doctor should see a maximum of 10 patients a day. But according to Tetanye Ekoe, the vice president of the National Order of Medical Doctors in Cameroon, “the doctor-to-patient ratio in Cameroon stands at one doctor per 40,000 inhabitants, and in remote areas such as the Far North and Eastern Regions, the ratio is closer to one doctor per 50,000 inhabitants.”

Okwen was in Lagdo testing out the SMS system, which was just implemented a few months back, when Duba’s daughter, Sally Aishatou, went into labour.

Okwen and the medical staff at the Lagdo District Hospital received an SMS from Aishatou. She had been in labour for 48 hours with no signs that the baby was about to come.

“What happens when a woman SMSes a particular number, the GPS location blinks on the server, and then the server tries to identify her location, puts it on Google maps; then tells the driver to go there. [The system] also tells the doctor to come to the hospital; tells the nurses to get ready. So everybody gets into motion,” he tells IPS.

Okwen and the ambulance driver traced Aishatou to her home. They found her lying helpless on a mat, almost passed out. By the time the ambulance returned to the hospital, the operation room was ready for her and she was taken into surgery immediately.

Eight minutes later, her 4.71 kg baby boy was born. The midwife Manou nee Djakaou tells IPS: “The joy in me is so great that I don’t even know how to express it. I am so exited; very happy. This system put in place is very efficient. But for this innovation, we stood to lose this baby and its mother.”

Two hours after surgery, Aishatou regained consciousness and named her boy after Okwen.

According to the U.N. Children’s Fund (UNICEF), out of every 100,000 live births 670 women in Cameroon die. UNICEF figures also state that for every 1,000 live births, 61 infants died in Cameroon in 2012.

“Many women are dying from child-birth related issues. Women are dying while giving life. And this is something we are really concerned about, but we also know that with the coming of mobile technology, there is hope for women in Africa,” Okwen says.

“Most of the women in Africa today have access to a telephone. It could be her own, her husband’s own, or a neighbour’s. So if we had a way in which women could reach an ambulance using a phone that would guide the ambulance, it could indeed present hope for African women,” he explains.

Okwen says the project has benefitted “close to one hundred women in terms of information, evacuation, arrangements of hospital visits, deliveries and caesarean sections.”

The project has been dubbed “Tsamounde”, which means hope in the local Fufuldé language.

Mama Abakai, the Mayor of Lagdo, says the project’s impact has been far reaching.

“A lot of our sisters, wives and mothers in rural areas lose their lives and suffer a lot, because there is a communication gap, and a problem of rapid intervention and assistance. With this system, it suffices to send an SMS or a simple beep, and all the actors involved in saving lives are mobilised…its formidable,” Abakai tells IPS.

Dr. Martina Baye of Cameroon’s Ministry of Public Health calls the project a “revolution in Cameroon’s health care delivery system.”

She says that as a majority of women in the country’s far North Region have little access to healthcare services, the M-Health Project comes as a huge relief.

According to the 2010 Population census, the Far North Region has a population of three million people, 52 percent of whom are women.

“We look forward to using this technology in other parts of the country,” she tells IPS.

Edited by: Nalisha Adams

The writer can be contacted at: https://www.facebook.com/ngala.killian

Elina Makore, 19, of Renco Mine just after delivering a healthy baby at Rutandare Clinic a remote Zimbabwean outpost supported by the United Nations Population Fund (UNFPA). Courtesy: UNFPA/Stewart Muchapera

By Hinda Deby Itno and Julitta Onabanjo
JOHANNESBURG, Sep 15 2014 (IPS)

Adolescence is a time of transition from childhood to adulthood. It is also a time of change and challenge. 

Today’s adolescents, connected to each other like never before, can be a significant source of social progress and cultural change.

But they are also facing multiple challenges that seriously impact their future. And nowhere in the world do adolescents confront as formidable barriers to their full development as in Africa.

Today, adolescents and young people make up over one third of Africa’s population. They form a sizeable part of the population yet they lack critical investments, especially where it matters most – in sexual and reproductive health services, comprehensive sexuality education and skills building.

This calls for the serious and committed attention of all.

  Challenges facing adolescent girls

It is estimated that Africa has the world’s highest rates of adolescent pregnancy and maternal mortality. In Chad, Guinea, Mali, and Niger, where child marriage is common, half of all teenage girls give birth before the age of 18.

This was the case for Zuera, a girl from Kano in northern Nigeria, who became a wife and a mother at just 14 years. She suffered the agony of two stillbirths and was treated for obstetric fistula, which is damage caused by childbirth that leaves a woman incontinent, that arose from her first pregnancy.

Zeura was robbed of her childhood. She also missed out on the transition phase of adolescence and finally, she missed life.

All over Africa, stories like Zeura’s are commonplace. Millions of girls become brides before the age of 15. Close to 30 percent of girls on the continent give birth by age 18, when they are still adolescents. These adolescents face a higher risk of complications and death due to pregnancy than older women.

Nearly two thirds of them lack the basic knowledge they need to access crucial sexuality education and health information to protect themselves from early pregnancy and sexually transmitted diseases.

Research has found that at least 60 percent of young people aged 10 to 24 years are unable to prevent HIV, due to a lack of sexuality education. We cannot allow this to continue.

A resilient and informed generation

Young people will carry the African continent into the future. They need a safe and successful passage to adulthood.

And this is not a privilege but a right. Yet this right can only be fulfilled if families, society, and government institutions make focused investments and provide opportunities to ensure that adolescents and youth progressively develop the knowledge, skills and resilience they need for a healthy, productive and fulfilling life.

Comprehensive sexuality education, sexual and reproductive health services, education and skills building for adolescents and young people need to be placed at the heart of the Sustainable Development Goals (SDGs), with specific indicators and targets.

By building a strong foundation and investing in programmes that focus on delivering and achieving specific results for adolescents, Africa can achieve its transformation agenda.

Our desire is for every young person in Africa to be resilient and informed. We want every young African to be able to make their own decisions, to foster healthy relationships, access proper health care, actively participate in their education and ultimately, contribute to the development of their community and their future.

This means that programmes that are achieving results for adolescents in various parts of Africa must be scaled up. These include the husbands’ schools that have been developed in Niger, the girls’ empowerment initiative in Ethiopia, and the child marriage-free zones in Tanzania.

International institutions need to increase their commitments to adolescents, and address the nagging problems that confront adolescent girls and women across the African continent.

Adolescents have the potential to shape their world and indeed, the world in its entirety. It is in our interest to connect with them and enable them to change our world. Yes indeed!

Edited by: Nalisha Adams

Excerpt:

Chief Yahya Louche of Bande, a village in Niger, addresses his constituents about maternal health and the importance of involving men. Credit: Joan Erakit/IPS

By Joan Erakit
BANDE, Niger, Sep 11 2014 (IPS)

It is a long, 14-hour drive from Niger’s capital city Niamey to the village of Bande. And the ride is a dreary one as the roadside is bare. The occasional, lone goat herder is spotted every few kilometres and the sightings become a cause of both confusion and excitement since there aren’t any trees, or watering holes in sight.

Dry, hot and often plagued with sandstorms, Niger has a population of over 17.2 million, 80 percent of which live in rural areas. Insecurity, drought and trans-border issues contribute to this West African nation’s fragility where 50 percent of its citizens have access to health services.

IPS has travelled here with the United Nations Population Fund (UNFPA) to visit a school that — on a continent where male involvement in maternal health is not the norm and, in fact, men are oftentimes not present during the duration of the pregnancy or the birthing process due to cultural reasons — is pretty unique. It’s the School of Husbands.

Formed with support from UNFPA in 2011, the school has over 137 locations in Niger’s southern region of Zinder. Members are married men between the ages of 25 and 50, but young boys are now being recruited to come and sit in on meetings — to learn from their elders.

As IPS arrives at the village early one morning, a group of musicians approach the vehicle playing ceremonial music; they precede a traditional chief who is being escorted by his most trusted counsel and a throng of personal security who frantically chase away curious children with sticks.

Yahya Louche is the chief of Bande and he stops to talk to IPS about maternal health and the importance of involving men.

“I am a member of the School of Husbands,” Louche says of the informal institution that brings together married men to discuss the gains of reproductive health, family planning and empowerment.

“The School of Husbands is where there is no teacher and there is not student,” Louche continues, adding, “They are not getting paid, they are working for the well being of the population.”

The School of Husbands is a prime example of what can happen when men stand shoulder to shoulder with women, promoting safe births.

The Perils of No Care 

While visiting the health centre near the chief’s homestead, IPS spots a young woman making her way across the compound to the maternity room. She is weak and can barely make eye contact while two friends hold her up by each arm.

IPS is told that she delivered a baby at home and has walked kilometres to get help because she began bleeding profusely – it is an obstetrical emergency known as postpartum haemorrhage (PPH).

According to the World Health Organisation (WHO), PPH is responsible for about 25 percent of maternal mortality. Without prenatal or antenatal visits during pregnancy, complications are more likely to arise — some often leading to death.

“Before the School of Husbands, women didn’t want to go for delivery at health centres, they would stay at home and have their babies,” Louche explains.

According to the World Bank, Niger has a Maternal Mortality Ration (MMR) of 630 to 100,000 live births.

Women in Niger suffer.

It is a very well-known custom in the country that women are not to show their pain or discomfort. When they give birth, it is often in silence.  The woman on the delivery table makes no sound though pain is very visible on her face.

Madame Doudou Aissatoo, a midwife in Konni, a town in Niger, tells IPS that it is important to have reproductive health and family planning services readily available because many women walk for miles to come to the health centres. If commodities and services, or even midwives are unavailable, the women will leave and not return for a very long time.

“The very critical thing is to integrate it in the package; when a woman comes to the health centre for whatever reason, she has to get the family planning right away, whether it is a routine health check-up or something serious. Even on Saturday or Sunday, if a woman comes to the health centre, she’ll get it,” Aissatoo says.

Returning Home to Promote Health

The ancient story is quite fascinating; when a young boy leaves his homestead to find greener pastures, a time will mostly likely come when the folks back home call upon the man to become chief.

Often leaving the diaspora to fulfil his duties, a request to become chief is one that cannot be refused for turning it down is the equivalent to shaming ones ancestors.

It is such that the chiefs in Niger today come from different professional backgrounds and many have been doctors, diplomats and professors.

Traditional chiefs in Niger are the most important leaders — even heads of state and presidents seek their council before making big decisions. Without their blessing, one can assume that the road ahead will be difficult.

The UNFPA country office has understood the role that traditional chiefs play and has built a partnership in favour of promoting the health and rights of women.

In 2012, the traditional chiefs of Niger signed an agreement with UNFPA furthering a commitment to improve the health conditions of women.

“When we gathered in 2012, we made a commitment as an organisation to work with UNFPA in order to reduce the demographic growth, be part of sensitisation activities and gear towards improving reproductive health,” Louche explains.

When asked if she feels good about her husband participating in the institution, Fassouma Manzo, a local woman replies ecstatically: “Very much!”

A round of applause follows Manzo’s declaration as she continues, “before the School of Husbands, men didn’t have discussions with their women; but now, there is an issue for which they are very interested. As a woman, you can now find a space where you can talk and share with your man.  It’s a great side effect!”

Louche, a charismatic chief who spends much time talking to his constituents truly believes that empowering men puts the focus put on women.

The School of Husbands doesn’t just highlight the importance of seeking professional medical care when pregnant, but it also works to promote understanding between men and women — a gain that will only foster harmony for both sexes.

Edited by: Nalisha Adams

The writer can be contacted through Twitter on: @Erakit

Excerpt:

The eight islands that comprise Turtle Islands, Sierra Leone, are remote and practically untouched by modern civilisation. Credit: Joan Erakit/IPS

By Joan Erakit
MATTRU JONG, Sierra Leone, Aug 26 2014 (IPS)

Emmanuel is a male midwife.

At the age of 26, he lives and works on one of eight islands off the southwest peninsular of Sierra Leone, an hour by speedboat from Mattru Jong, the capital of Bonthe District.

On a particularly hot Wednesday morning, IPS joins Marie Stopes, United Nations Population Fund (UNFPA) and Sierra Leone’s Ministry of Health to go and visit a population on one of the Turtle Islands that is practically untouched by modern civilisation.

Marie Stopes is a British-based non-profit that provides family planning and reproductive health services to over 30 countries around the world. They work as a back-up support system to the government, filling in the gaps in hard-to-reach areas that the government is still working to resource.

On the mainland of Mattru Jong there is a small market, situated on the river Jong which flows into the Atlantic ocean, and crowded with various kiosks boasting fish, vegetables and live chickens tied at their feet in straw baskets.

To reach the islands, one has to travel by boat. But all the islands don’t have landing docks and the boats sometimes stop in knee-deep water. Passengers — and midwives visiting the islands to provide reproductive health and family planning services — have to hoist their belongings and supplies above water, to make their way to the villages.

“Their [midwives] challenge is that they don’t have a boat. If you want to do this effectively, you need a good boat,” Safiatu Foday, a regional family planning coordinator for UNFPA in Sierra Leone, explained to IPS.

For island communities that have very little access to the mainland, basic health information is difficult to come by, therefore the risks — especially those pertaining to pregnancy, become inevitable.

With a population of over six million, where women of childbearing age are between the ages of 15 and 49, this West African country has refocused its health initiatives, working tirelessly to strengthen the capacity and training of skilled midwives — an exceptional tool in reducing maternal and infant mortality.

It Takes a Village

The village is inhabited by about a few hundred people — most of them large families, many of whom have just started utilising the peripheral health unit (PHU) that is onsite.

Emmanuel, one of the first men to undertake the position of midwife in this area, is the person “in-charge,” facilitating prenatal visits, deliveries, antenatal care, attending to illnesses and referring patients to a hospital when needed.  

“There are people who since their birth, have never left the island,” Fadoy said.

Some of the women say they have delivered 13 or 14 children prior to the work of Marie Stopes in their village.

Others recount having no time to “rest” or take care of their other children while being pregnant almost every year.

There are common reasons as to why women become pregnant so consistently.

One woman shares that there is a fear of being “abandoned” by one’s husband. The women say if they do not engage in sexual intercourse during the marriage, their husbands will look elsewhere. Therefore women feel they have no choice but to keep getting pregnant.

There is also the question of approval; many women must obtain permission from their husbands to start using contraceptives.

“We used to get pregnant all the time and our husbands would abandon us, so we had to fight for ourselves to survive. Since Marie Stopes came to the island and we now have access to contraceptives, we are able to take care of ourselves,” Yeanga, 33 tells IPS, adding, “It has created an impact in my life, one, because I now know about spacing births.”

Yeanga is the mother of five children with the oldest aged 25, and the youngest only three years old.

Before going on family planning, Yeanga admits to having difficulties with her husband, which were only heightened when he found out that contraceptives would help her not to get pregnant.

“Even when I wanted to join family planning, my husband was not agreeing, but I talked to him about it and we finally agreed to allow me to start family planning.”

In order to fully meet the demand of women who are in search of family planning and reproductive health services, the government has come up with an interesting strategy: recruit and train traditional birth attendants (TBA’s) to provide quality health care services in the villages.

Because they are from the village, they are both respected and valued, thus their insight, advice and knowledge are taken very seriously.

“Before midwives came to the island, there were just TBA’s doing deliveries in this area – and there were a lot of problems with these births,” Isatu Jalloh, 28, a nurse working in the village, told IPS.

Without skilled birth attendants, many of the women on the island suffered complications like preeclampsia, fistula and even death.

Though Sierra Leone has one of the highest maternal and infant mortality rates, 140 infant deaths per 1,000 live births, and 857 maternal deaths per 100,000 live births, Jalloh believes that the maternal death rate on the island has reduced due to the advocacy of midwives who travel to the island to promote family planning and reproductive health.

The ability to choose when to have children has allowed women on the island to pursue small economic ventures. They are able to produce an income to not only take care of themselves, but also their children.

The Future is Bright?

As the last few hundred days of the United Nations Millennium Development Goals (MDGs) come to a close, Sierra Leone stands at an interesting cross section: that of incremental success and challenges to come.

Demand for reproductive health and family planning services is high, the commodities are being supplied through partnerships with UNFPA and Marie Stopes, midwives are being dispatched to different districts, yet obstacles remain.

Most trained midwives deployed to health centres far from their homes don’t want to stay in those areas due to harsh working conditions and unfamiliarity with their surroundings.

And with the outbreak of Ebola, most midwives have been immediately evacuated, leaving patients, many of them pregnant women, without proper care.

Sierra Leone faces an opportunity to scale-up its reproductive health and family planning services by continuing its ability for form essential partnerships, most effectively illustrated in the one with civil society and advocacy group, Health Coalition for All.

“Our focus is on health and health-related issues. The key areas are advocacy and monitory, we work to ensure that services are available, accessible, affordable and that they reach the beneficiary,” Al Hassane B. Kamara, a programme manager for the coalition, shared with IPS.

Based in Makeni, in Northern Province, the Health Coalition for All has played an essential role in ensuring that women have access to healthcare, especially during pregnancy.

By addressing the issues such as lack of trained staff, delivery of commodities and most importantly, the high user fees during clinic visits, the coalition takes a proactive stand to ensure that women do not end up in unqualified hands.

“They pay very high fees to see a qualified doctor, especially for cesarean operations.  As a result they have no options but to work with the TBA or a “quack doctor.”

With programmes such as the Free Health Care Initiative (FHCI) that allows pregnant mothers, lactating mothers and children under the age of five to access services for free, Sierra Leone continues to put its focus on reproductive health.

 Edited by: Nalisha Adams

The writer can be contacted through Twitter on: @Erakit

Excerpt:

Uganda has been hailed as a success story in fighting HIV/AIDS, with prevalence rates dropping from 18 percent in 1992 to 6.4 percent in 2005. But activists fear a new HIV Bill will lead to lead to people shunning testing and treatment. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 21 2014 (IPS)

HIV/AIDS activists are adamant Uganda will not achieve an “AIDS-free generation” now a “backwards” HIV/AIDS Bill criminalising the “wilful and intentional” transmission of the disease has been signed into law.

The act, they say, will lead to people shunning testing and treatment, but will particularly drive sex workers and gay men underground, and make women more vulnerable to domestic violence.

News that the controversial law, adopted unanimously by Parliament on May 13, and assented to by Uganda’s President Yoweri Museveni on Jul 31, broke on social media only this week on Aug. 19.

The bill also allows medical providers to disclose a patient’s HIV status to others without consent and prescribes mandatory testing for pregnant women, their partners, and victims of sexual offences.

Uganda has been hailed as a success story in fighting HIV/AIDS, with prevalence rates dropping from 18 percent in 1992 to 6.4 percent in 2005.

But Museveni went against earlier promises to the Joint United Nations Programme on HIV/AIDS (UNAIDS) executive director and campaigners that he wouldn’t back the punitive law.

“This is a populist act,” Kikonyongo Kivumbi of the Uganda Health and Science Press Association (UHSPA-Uganda) told IPS.

“He knows what he’s doing is not the right thing in addressing the general public health concerns in this country.”

Kivumbi pointed out that according to the 2014 UNAIDS Global Progress report, Uganda was now the third country in the world contributing to sustaining the pandemic.

Other campaigners are “heartbroken” and “outraged” after the president approved the HIV Prevention and Control Bill.

The news broke as CSOs were still waiting for an audience with Museveni over the controversial bill, which has been slammed by Uganda’s own AIDS Commission and the AIDS Control programme of the Ministry of Health (MoH).

“Some bad news from Uganda. Please pray for us,” Jacquelyne Alesi, director or programmes at Uganda Network of Young People Living with HIV & AIDS (UNYPA), said in an email to IPS.

The legislation prescribes a maximum 10 years in jail, a fine of about five million Ugandan shillings (1,980 dollars) or both for anyone who “willfully and intentionally transmitting HIV/AIDS to another person”.

Another provision of the law, drafted in 2008, provides for a fine or a maximum five years in jail for those convicted of “attempted transmission”.

According to the 2011 Uganda AIDS Indicator Survey, overall HIV prevalence is higher among women (8.3 percent) than among men (6.1 percent).

“Usually HIV bears the face of a woman,” Dorcas Amoding, policy, advocacy and networking officer for Action Group for Health Human Rights and HIV/AIDS (AGHA-U), told IPS.

“So if she has tested positive and perhaps the husband becomes aware of it…he might treat this as a very negative result as well and she can be attacked.”

Amoding added, “it even brings about a very huge burden in terms of women inheriting property, because some people still think HIV is a death sentence.”

“So if I say ‘I want to have my husband’s property for the children’, people are going to say ‘you’ll die tomorrow, you’re HIV positive.’”

Most LGBT people with HIV/AIDS already “die silently” and many were no longer going for services in the after the passing of the Anti-Homosexual Act, Bernard Ssembatya, from Vinacef Uganda, a sexual health and reproductive NGO focusing on HIV, told IPS. The anti-gay law was, however, declared “null and void” by the constitutional court on a legality earlier this month.

“Some of them are wary of going to health services, some health providers are also scared of delivering services,” Ssembatya said.

There will be “an increase in deaths from HIV, more infections” as a result of the HIV/AIDS law, he warned.

According to AIDS Free World, over 60 countries criminalise the transmission of HIV or the failure to disclose one’s HIV status to sex partners, or both. Global Commission on HIV and the Law members have highlighted Guinea, Senegal and Togo, which they say in recent years have revised existing, or adopted new laws which limit HIV transmission to exceptional cases of wilful transmission.

Guyana also rejected a criminalisation law. In the U.S, 34 states still have HIV specific criminal statutes, however, in May Iowa approved a law revising a HIV specific statute.

Kivumbi pointed out that criminalisation was an “agenda of the U.S. republican right”, who he accused of influencing political and public health appointments in Uganda.

“We need to tell U.S. republican extremists and evangelical Christians to leave managing the HIV pandemic to ourselves,” he said.

“Just because the U.S. gives us money it does not mean [they] can impose their extremist agenda on us.”

Uganda had deliberately chosen to “moralise the pandemic and response, emphasising abstinence at the expense of condom use and other scientifically proven interventions,” Kivumbi said.

“We have had cabinet ministers, parliamentarians and other people at senior government level saying that people who are HIV positive are morally bankrupt,” the activist said.

Kivumbi said there was an “element of politicking” on Museveni’s part in inking his signature on the bill. Uganda will be submitting a “concept note” to the Global Fund to Fight AIDS, Tuberculosis and Malaria on Oct. 15, and wanted to get access to a 90-million-dollar loan from the World Bank that was suspended, he said.

One clause of the HIV/AIDS Bill seeks to set up an AIDS Trust Fund managed by the MoH, with money coming from foreign governments and international agencies, among other means.

Ironically, that loan was put on hold in February, just days after the president approved the Anti-Homosexuality Act.

“I think that the president thought that by signing this law, which [sets up] the AIDS Trust Fund, the World Bank would give him money and the Global Fund would contribute,” said Kivumbi.

“Let the Global Fund and the World Bank not be fooled.

”This law tramples upon basic civil liberties and cannot be acceptable in a free and democratic society that Uganda aspires to be.”

Dianah Nanjeho, a communications consultant at Uganda Network on Law, Ethics and HIV/AIDS (UGANET), which works with a coalition of 40 organisations, told IPS the activists wanted the contentious clauses in the bill to be amended.

“The act in itself is a good act we don’t condemn it, we just want those one, two three things sorted out.”

She said the positive parts of the law were state obligations to provide care and treatment and the establishment of the AIDS Trust Fund.

Nanjeho said CSOs, who are still hoping to meet Museveni, hadn’t ruled out challenging the law in court, and would make a decision on this in the next few days.

“For now we are all weighing all options,” she said.

Edited by: Nalisha Adams

The writer can be contacted on Twitter @amyfallon 

Contraception is a smart choice but HIV positive women have to jump through the hooks to get it. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 18 2014 (IPS)

Barbara Kemigisa used to call herself an “HIV/AIDS campaigner”. These days she would rather be known as an “HIV/AIDS family planning campaigner”.

“We need to reduce unplanned pregnancies and the HIV infection rate in our country,” Kemigisa told IPS during Uganda’s first national family planning conference on July 28. “It’s about dual protection.”

Raped by two uncles from an early age, Kemigisa later became promiscuous. When she was 22, she discovered she was HIV positive – and two months pregnant. Her daughter, Kourtney, now five, was born negative. But the mother couldn’t afford to buy her formula milk and, when she was just six-months-old, the baby tested positive, through breastfeeding.

Kemigisa, an informed activist who gets her ARVs the Infectious Diseases Institute at Mulago Hospital and works with KiBO Foundation in Kampala,never had any problem obtaining contraceptives.

The same can’t be said for many young HIV positive women Kemigisa regularly meets.

“Health workers tell them ‘you’re positive, you’re not supposed to be having children’,” she says.

In the last decade, Uganda’s modern contraceptive use among women has slowly increased from 18 percent to 26 percent.

Though low, this level of contraceptive use likely averted 20 percent of paediatric HIV infections and 13 percent of AIDS-related children’s deaths, says a study. Expanding family planning services can substantially reduce child infections, it concluded.

This is crucial. Uganda’s HIV infection rate of seven percent is steadily rising after a steep drop in the 1990s, when more than a quarter of the population was infected.

Uganda now accounts for the third largest number of annual new HIV infections in the world, after South Africa and Nigeria, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Turning women away

Contraception is the second pillar of preventing mother to child HIV transmission (PMTCT) but one that is often neglected although, at an average of six children per woman, Uganda has one of the world’s highest fertility rates.

Women trying to cope with HIV also struggle to get the “right and correct information” on family planning, says Dorothy Namutamba, of the International Community of Women living with HIV/AIDS Eastern Africa (ICWEA).

“Information doesn’t reach women living with HIV in their reproductive age,” she says.

Women may face violence at home for being HIV positive and for using contraception, only to be further mistreated when they turn to health workers, says Namutamba.

“Some are told ‘oh, this is best for you’ and brushed off at the health facility,” says Namutamba.

In the worst-case scenarios, some HIV positive women have undergone coerced sterilisation.

Namutamba says this may happen when the woman has a caesarean section or goes for family planning services: “They’re told that this is the best for you as a HIV positive woman.”

In Kenya, ICWEA and other groups have documented about fifty cases of coerced sterilisation and will release later this year a report about similar cases in Uganda.

Because of discriminatory attitudes, “a large percentage of women are hesitant to share their status with health workers when they come to receive family planning services,” Dr Deepmala Mahla, country director for Marie Stopes Uganda, told IPS.

Two services, one trip

Inadequate coverage, frequent stock outs of commodities, limited offer of contraceptive methods and lack of trained staff affect family planning services for all women in Uganda, says Dr Primo Madra, programme officer with the United Nations Population Fund (UNFPA) in Kampala.

But for women living with HIV, he says, the main problem is the time and effort required.

An HIV positive woman who goes to the clinic for a refill of ARV pills must line up at the HIV clinic and then at the family planning clinic, both likely with long queues. She may have to do two trips.

“Most often the woman will prioritise the ARVs,” says Madra.

In a number of districts, the government and UNFPA are setting up “one-stop-shops” that offer both HIV and reproductive health services, and training health workers in the new system.

“This will enable a woman who walks into an ARV clinic to access all services more conveniently,” Primo told IPS.

But, he adds, the nationwide rollout of one-stop-shops is constrained by lack of staff: “Many health facilities have vacant health worker positions and are overwhelmed by the patient load.”

Edited by: Mercedes Sayagues

Excerpt:

Because men wield power in decisions around pregnancy, family planning services should include them. Couple-centred family planning services are sorely needed in Africa. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Aug 14 2014 (IPS)

Beatrice Njeri had just come home from her job as a janitor at a primary school in Nairobi. It was August 2009.

Arriving home earlier than usual, the married mother of two found her husband waiting for her in their shanty at Kisumu Ndogo, in the sprawling Kibera slums.

He had just discovered he was HIV positive. A week later, she too tested positive.

Both were 29 years old at the time. “We were very young and knew very little about HIV,” she says.

Having had two daughters, both HIV negative, they desired a son, but decided not to have another baby.

At the time, to prevent pregnancy, Njeri was on Depo-Provera, a hormone injection that lasts three months, and she needed a new shot.

On discovering that Njeri was HIV positive, the nurses encouraged her to undergo tubal ligation as a permanent birth control method – a step that neither Njeri nor her husband were prepared to take.

Unbeknown to Njeri, during this period, the country was facing a massive contraceptives shortage. It was so bad that rumours spread that women seeking the hormone injection, the most popular, family planning method, were injected with water instead of the hormone.

Njeri told IPS that the nurses said that they were giving priority to other women with pressing need of contraceptives.

“They said I was being selfish for not agreeing to have my tubes tied,” she says. “The nurses were forcing me to give up the only thing that made me feel like a real woman. I did not want that taken away from me.”

Sex became a chore

She was advised to use a condom to prevent a pregnancy. Condoms were new to them, and not easy.

“Using it all the time was very difficult. Sex became a chore. I hated it,” she says.

Price was another issue. “We are both casual labourers. In the slums, putting food on the table is the only priority,” she says. Their sole support comes from her church, parcels of clothes and food every now and then.

Njeri shared her predicament with a traditional birth attendant, who advised her to only have sex on safe days.

But neither knew that antibiotics can interfere with the menstruation cycle, and Njeri was taking them to fend off HIV-related opportunistic infections.  This made safe days ineffective as a contraceptive method.

Eight months later, Njeri found out that she had conceived. At her first antenatal visit, her CD4 count was a low 400. After delivering her baby boy in 2011, she was down to 180. She began using antiretrovirals, as did her husband.

But her son is infected with HIV.

Although Njeri was on the prevention of mother to child transmission program at the government’s Mbagathi Hospital near Kibera, she chose to deliver with a traditional birth attendant because they are kinder than hospital staff.

“Most government hospitals are too crowded; they don’t have time to show kindness or respect. You are lucky if a nurse actually attends to you,” she says.

Between 2012 and 2013, a series of labor strikes in the health sector resulted in shortages of injectables. Reluctantly, the couple resorted to condoms.

Being HIV positive, sexually active and young enough to get pregnant is a big problem, she says.

“Many health facilities are not able to take care of our needs,” she told IPS.

Some clinics have set aside a day of family planning services for HIV positive women but Njeri is not always able to attend because of work.

For now, Njeri is back on the injectable contraceptive. She prays that when she returns to the clinic in two months for another injection, it will still be available.

Edited by: Mercedes Sayagues

Excerpt:

The contraceptive needs of HIV positive women are often put on the background. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Aug 14 2014 (IPS)

In the rush to save babies from HIV infection and treat their mothers, experts warn that a key element of HIV prevention is being neglected in Africa – contraceptives for HIV positive women.

Yet contraception is the second pillar of successful prevention of HIV transmission from mother to child (PMTCT), along with preventing infection among women and babies, and caring for those infected.

“The contraceptive needs of HIV positive women are often put on the background, the main focus is on keeping mother and child healthy,” Florence Ngobeni-Allen, a spokesperson with the  Elizabeth Glaser Paediatric AIDS Foundation, told IPS. A South African, she was diagnosed with HIV in 1996, lost a baby to AIDS and now has two healthy boys.

Contraception is crucial in East and Southern Africa, where high HIV prevalence combines with high unmet needs for family planning, and where eight in ten HIV positive women are within their reproductive years, according to the United Nations Population Fund (UNFPA). 

Studies suggest that women living with HIV have equal “if not more desire to limit childbearing compared with HIV negative women. Reducing unmet need for family planning among these women is critical for meeting the target of reducing new child HIV infections by 90 percent,” says the United Nations report Women Out Loud.

Surveys of HIV positive women in Kenya and Malawi show that nearly three-quarters did not want more children within the next two years or ever, but only a quarter used modern contraceptives.

Weakness in programmes

A study by Family Health International among HIV positive women in Rwanda, Kenya and South Africa showed that more than half did not plan their most recent pregnancy.

Although the women wanted family planning, access was difficult. One barrier was health staff: they were not trained on contraceptive options for women living with HIV; had misconceptions about contraceptive safety; most only offered male condoms, although women preferred long-acting implants and injections, and many were judgmental about the women’s sex lives

“Sometimes nurses forget that women are still sexual when they find out you are HIV positive,” says Ngobeni-Allen.

Kenya’s unmet need for contraceptives is 25 percent nationwide but 60 percent among HIV positive women, Dr John Ong’ech, assistant director at Kenyatta National Hospital, told IPS.

Low access to family planning for HIV positive women, who are six to eight times more likely to die from pregnancy-related complications compared to HIV negative women, “is a weakness in health programmes,” he told IPS, although it is cheaper and more effective to provide contraceptives than PMTCT.

Husbands and mothers-in-law

Mary Naliaka, who works in paediatric AIDS in Kenya’s health ministry, told IPS that family planning should be part of the HIV treatment package and offer a variety of contraceptive options.

But the health systems in East and Southern Africa often suffer commodity stock outs and many clinics lack adequate infrastructure.

“To insert an intrauterine device you need a sterile environment,” Ong’ech says.

Injection is the most popular method because women can use it without telling the husband, he adds.

Unequal gender relationships and weak negotiating power influence contraceptive use. Naliaka observes that in African culture, “the mother-in-law can engineer the end of a marriage if a baby is not forthcoming.”

Dorothy Namutamba, of the International Community of Women Living with HIV in East Africa (ICWEA), who is based in Kampala, Uganda, told IPS that women are raised to please husbands.

“If a man demands that you should have ten children [you must] and if you’re not able, he’ll look somewhere else,” she says. “Most men do not encourage women to go on family planning, it’s a big problem.”

Stigma and domestic violence compound the problem.  “Women fear to declare their HIV status because they may face gender violence, and this limits their access to family planning,” Anthony Mbonye, Commissioner of Health Services in Uganda, told IPS.

Given men’s power over decisions about pregnancy, couple-oriented reproductive health services are crucial, but “health facilities are too overcrowded to absorb the male partner,” Naliaka told IPS.

The coerced sterilisations of HIV positive women in Kenya, Malawi, Namibia, South Africa and Zambia, with lawsuits pending, further cloud the issue of reproductive rights and needs and HIV.

“This shamed the health sector,” says Naliaka.  However, she adds, “through these publicized cases, the health sector and the public have understood that these women have reproductive health needs similar to those of HIV negative women.”

One-stop shops

Moving forward, experts recommend integrating HIV, family planning and maternal and child health care services, saving time for both users and health staff.

Seven Southern African countries have set up such “one-stop shops” for reproductive health, where a woman can get ARVs, cervical cancer screening, breastfeeding advice and family planning in one visit, under one roof, sometimes in one room with one health worker.

Linking services is cost effective and efficient, says UNFPA. It makes “people sense”.

Edited by: Mercedes Sayagues

Excerpt:

The budgets of many African countries reflect greater interest in arms deals than in managing the deadly HIV epidemic. Credit: Thomas Martinez/IPS

By Kanya D'Almeida and Mercedes Sayagues
JOHANNESBURG/NEW YORK, Aug 13 2014 (IPS)

They say there is a war on and its target is the deadly human immunodeficiency virus (HIV).   

This war runs worldwide but its main battleground is sub-Saharan Africa, where seven out of 10 HIV positive persons in the world live – 24.7 million in 2013. The region suffered up to 1.3 million AIDS-related deaths in the same year, according to the United Nations.

A ragtag army is fighting the war on AIDS. Sometimes it is comprised of well-dressed aid officials sitting in conference rooms allocating funds. At other times, it deploys shabby foot soldiers – community healthcare workers and AIDS activists – into desolate rural areas with no running water, let alone antiretroviral therapy.

With many competing health problems, funding for AIDS is a growing concern. Yet a look at the defence of budgets of several countries plagued by HIV portrays a startling picture of governments’ priorities, with huge military expenditures belying the argument that the key obstacle to winning the war against AIDS is money.

And, as the 2015 deadline for the United Nations Millennium Development Goals looms large – with donor countries tightening their purse strings – health experts worry about financing for HIV prevention and AIDS treatment after 2015.

New funding for AIDS in low- and middle-incoming countries fell three percent from 2012 to 8.1 billion dollars in 2013, says a joint report by the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) released in June.

Five of the 14 major donor governments – the U.S., Canada, Italy, Japan and the Netherlands – decreased AIDS spending last year.

And yet, while governments claim to be too cash-strapped to fight the AIDS war, funding for other wars seems much more forthcoming.

Spending on arms and on AIDS

Africa will need to do more with less to manage AIDS, concludes a 2013 UNAIDS report entitled Smart Investments.

In Kenya, a funding shortfall is expected soon, since the World Bank’s 115 million-dollar ‘Total War on HIV/AIDS’ project expired last month.

Meanwhile, the country’s defence budget is expected to grow from 4.3 billion dollars in 2012-2014 to 5.5 billion dollars by 2018, as the country stocks up on helicopters, drones and border surveillance equipment, according to the news portal DefenceWeb.

True, Kenya is under attack from Al-Shabaab terrorists. Still, five out of 10 pregnant Kenyan women living with HIV do not get ARVs to protect their babies.

Mozambique’s fighter jets

In Mozambique, a dearth of funding puts the country’s recent military expenditures into a harsh light.

Daniel Kertesz, the World Health Organization representative in Mozambique, told IPS the country’s six-year health program has a 200 million dollar finance gap per year.

Mozambique being very poor, it is difficult to see how the country – with 1.6 million infected people, the world’s eighth burden – will meet its domestic commitments.

“Today, Mozambique spends between 30 and 35 dollars per person per year on health. WHO recommends a minimum of 55-60 per person per year,” Kertesz said.

The same week, the government announced it had fixed eight military fighter jets, which it had discarded 15 years ago, in Romania, and is receiving three Embraer Tucano military aircraft from Brazil for free, with the understanding that purchase of three  fighter jets will follow.

According to a 2014 report by the Economic Intelligence Unit, Mozambique’s spending on state security is expected to rise sharply, partly owing to the acquisition, by the ministry of defence, of 24 fishing trawlers and six patrol and interceptor ships at the cost of 300 million dollars – equal to half the 2014 national health budget of 635.8 million dollars.

 The same week the refurbished fighter jets landed at Maputo airport, the press reported that the main hospital in Mozambique’s north-western and coal-rich Tete province went for five days without water.

Indeed, the country’s public health system is in such dire straits that the United States President’s Emergency Plan for AIDS Relief (PEPFAR) meets 90 percent of the health ministry’s annual AIDS budget.

“The state budget for social programmes is not increasing at the same level as military, defence and security spending,” Jorge Matine, a researcher at Mozambique’s Centre for Public Integrity (CIP), told IPS.

“We have been pushing for accountability around the acquisition of commercial and military ships for millions of dollars,” he said.

A coalition of NGOs has requested the government to explain “its decision to spend that money without authorisation from Parliament when the country is experiencing severe shortages of personnel and supplies in the health sector,” Matine explained.

The coalition argues that, if defence spending remained as it was in 2011, the country would save 70 million dollars, which could buy 1,400 ambulances (11 per district, when many districts have only one or two) or import 21 percent more medicines.

A similar pattern unfolds across the continent where, according to the Stockholm International Peace Research Institute (SIPRI), military spending reached an estimated 44.4 billion dollars in 2013, an 8.3 percent increase from the previous year. In Angola and Algeria, high oil revenues fuel the buying spree.

The South Africa-based Ceasefire Campaign reported recently that arms deals with private companies are also on the rise in Africa, with governments expected to sign deals with global defence companies totalling roughly 20 billion dollars over the next decade.

Credit: Marshall Patstanza and Nqabomzi Bikitsha/IPS

Failing Abuja 

At the same time, the 2001 Abuja Declaration, whose signatories committed to allocating at least 15 percent of gross domestic product to health, has “barely become a reality”, Vuyiseka Dubula, general-secretary of the South Africa-based Treatment Action Campaign, told IPS.

 “Regardless of our calls, very few countries have even come close to 12 percent, including some of the richer African countries such as South Africa and Nigeria,” Dubula said.

Between 2000-2005, she added, “almost 400,000 people died from AIDS in South Africa; during that same period we spent so much money on arms we don’t need, and one wonders whether that was a responsible [use] of public resources.”

Mozambique is a sad example of Abuja failure. Back in 2001, Mozambique’s health budget represented 14 percent of the total state budget, tailing the Abuja target. It declined to a low of seven percent in 2011 and clawed to eight percent since.

“Financing mirrors the priorities of the government,” Tedros Adhanom Ghebreyesus, Ethiopia’s minister of foreign affairs and former minister of health, told IPS. “We have seen that in countries that had the political will to turn around their health sectors, they upscale finance and really invest in the health sector.”

If this is true, the budgets of many African countries reflect greater interest in arms deals than in managing the deadly HIV epidemic.

Edited by: Mercedes Sayagues

COUNTDOWN SNAPSHOT: HOW MOZAMBIQUE IS COPING WITH AIDS

By Mercedes Sayagues
MAPUTO, Aug 12 2014 (IPS)

Mozambique struggles to contain the HIV epidemic with one in ten among its 24 million people infected. Helping them is not easy when only 60 percent of people have access to health services.

There are five doctors and 25 nurses per 100,000 people. In neighbouring South Africa, the ratio is 55 doctors and 383 nurses.

Recently, the United Nations ranked Mozambique 178 among 187 countries in human development. Quick stats:

• 50 years: life expectancy
• 3: mean years of schooling
• 70 percent: number of people living in poverty
• 40 percent: number of women who give birth at home
• 56 000: number of women infected with HIV annually

Excessive dependence on donors is another problem, with 90 percent of the health ministry’s HIV/AIDS budget paid by theUnited States President’s Emergency Plan for AIDS Relief (PEPFAR). The overall health budget is just eight percent of the total state budget, far from reaching the 2001 Abuja commitment to allocate 15 percent to health.

Nonetheless, Mozambique is doing quite well in preventing mother to child HIV transmission. Infection rates among children have plummeted, but remain too high at 12,000 in 2013. The good news is that this number is half of what it was five years ago.

Sources: UNAIDS, UNICEF

Nigeria accounts for one third of all new infections among children in the 20 worst hit countries in sub-Saharan Africa. Credit: Sam Olukoya/IPS

By Sam Olukoya
LAGOS, Nigeria, Aug 4 2014 (IPS)

Tope Tayo’s marriage broke up 11 years ago after she tested positive for HIV. Her angry and embarrassed husband took away their only child. Three months later, when the one year old boy tested positive, the husband dumped him with Tayo and absconded.

 “He abandoned us as if we had committed a crime but I told him HIV is not a crime,” Tayo told IPS.

She was jobless and the husband paid no maintenance. “I walked the streets crying, I was living on charity,” Tayo recalls.

The runaway man who abandons his HIV positive wife and children is a common feature in Nigeria, says Rosemary Hua, coordinator of the First Step Action for Children, an organisation that advocates for child rights.

“Fathers withdraw their support because they feel there is no need to invest in a child that is likely to die young,” Hua told IPS.

Nigeria’s HIV infection rate of 3.2 percent appears low in comparison to southern Africa’s, but with a population of 173 million, it translates into huge numbers – 3.4 million Nigerians lived with HIV in 2013.

Source: Nigeria report to UNGASS 2014

Of these, 430,000 are children under 14, according to a recent report of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Nigeria accounts for one third of all new infections among children in the 20 worst hit countries in sub-Saharan Africa.

The report says Nigeria faces “the triple threat of high HIV burden, low treatment coverage and no or little decline in new HIV infections.”

Moreover, the national HIV rate conceals sharp disparities among the 36 states: in four, prevalence ranges from eight to 15 percent.

Why women avoid testing

Tayo and her son have been taking antiretroviral drugs for the last 11 years. They are lucky. Fewer than 600,000 Nigerians are on treatment, or 20 percent of those who need it.

Low treatment coverage perpetuates misconceptions and stigma, as Tayo’s story show.

Abandonment usually translates into economic hardship. Half of women are unemployed in Nigeria.

“The desperation to take care of herself and her child could drive an HIV positive woman into sexual activities to raise money and this could further spread HIV,” says Lucy Attah, a gender activist who lives with HIV. She is executive director of Women and Children of Hope Foundation, which helps HIV positive women, and where IPS met Tayo.

Tayo told IPS she avoided testing for HIV while pregnant. Nigerian public hospitals do routine HIV testing of pregnant women but fear of discrimination if found positive led Tayo to a private hospital where testing was not required.

“It is the biggest regret of my life,” she told IPS.

One reason that pregnant women shun testing, says Hua, is health workers’  “lack of professionalism by not keeping HIV results confidential.”

“At times we had to transfer patients to other hospitals far from where they live because of the disclosure of their HIV status,” she told IPS.

Some health workers avoid any contact with HIV positive women because they mistakenly believe they can contract the virus by mere touching, says Attah.

“On the surface, it seems there is a lot of awareness among health workers but in reality there is a lot of stigma,” says Attah.

An anti-discrimination and confidentiality law has been approved by both houses and is waiting for President Goodluck Jonathan to sign it.

But Nigeria needs more than laws to address the epidemic.

In 2012, UNAIDS described the country’s response as “stagnant” and requiring “a massive effort.”

Nigeria accounts for 13 percent of all HIV positive people and 19 percent of all AIDS-related deaths in sub-Saharan Africa, according to UNAIDS.

Only Chad ranks lower than Nigeria in treatment coverage of HIV positive pregnant women. (see graph)

Source: UNAIDS Gap report 2014

Some good news

Since that damning description, the government has taken bold steps to reduce transmission from mothers to babies (PMTCT) among the 12-worst hit states.

PMTCT coverage went up to by 27 percent in 2013, a significant increase from 19 percent in 2012, according to the United Nations Children’s Fund (UNICEF).

Some states doubled or tripled the number of clinics providing HIV services, bringing the number of PMTCT sites to 2,216 – still far from the 16,400 required for adequate coverage.

The annual number of new child infections went down from 60,000 in 2012 to 51,000 in 2013.

But, with two in three pregnant women shunning antenatal care, the challenge will be reaching them through improvement of services and outreach.

“We must go to them instead of waiting for them to come to the health facility,” Arjan de Wagt, chief for children and HIV with UNICEF in Nigeria, told IPS. “Otherwise, children will continue dying of AIDS unnecessarily.”

Edited by: Mercedes Sayagues

Senegal has low HIV prevalence but high stigma, and children living with HIV suffer the consequences. Courtesy: Mercedes Sayagues

By Mathilde Cru
DAKAR, Aug 2 2014 (IPS)

Children living with HIV in Senegal suffer because of the taboo associated with this disease in a country which is, however, praised for its fight against the pandemic.

“I don’t want my son’s HIV status to be known, my family would not take it well,” explains Fanta (39), who is herself HIV positive.

“The word AIDS is too loaded,” says this mother of three children, one of whom was born HIV positive 14 years ago, and who fears that both she and her teenage son would be disowned by the family if the secret was revealed.

“My mother doesn’t know, she wouldn’t be able to keep it to herself, I am suspicious of everyone,” she told IPS, adding that her other two children do not know her and their brother’s HIV status.

According to a survey conducted on 626 HIV positive people in Senegal by the National Network for People Living with HIV/AIDS (RNP+), less than half of them have told their partners about their HIV status and only 28 percent have told at least one member of their family.

“I  had to talk about it [my HIV status] with my father, because if I die one day, I don’t want people to think it is because of voodoo,” Fanta told IPS, referring to the practice of witchcraft which, according to some, brings sudden death.

As a result of reacting swiftly to the first cases of AIDS, Senegal’s HIV prevalence rate is estimated at 0.7 percent of the population, compared to 4.7 percent in Ivory Coast and 3.2 percent in Nigeria, the worst hit West African countries according to the United Nations.

Left high and dry

The stigma attached to the disease, however, has an adverse effect on continuity of care for the child living with HIV.

Mbaye Mboye, programme head at Synergy for Childhood, an organisation which manages a paediatric AIDS unit in Guediwaye, in Dakar Region, explains that when the parent of an infected child dies or when the guardian remarries or moves, it is rare for anyone to take over responsibility for care.

“We have problems with guardians, sometimes they forget to give medication, sometimes they are preoccupied with other issues,” Mbaye Mboye told IPS.

“But we prefer the child’s HIV status to be disclosed to a very limited few to maintain confidentiality,” he adds.

This concern with confidentiality requires some creativity from both social workers and guardians, who may have to fabricate visits to imaginary relatives in order to go for appointments.

“Our social workers pretend to be family friends when they do home visits and they must verify that the person who answers the phone is the guardian on file at the hospital,” says Mbaye Mboye.

According to the National Council for the Fight against AIDS (CNLS), some 6,500 children under the age of 15 were living with HIV in Senegal in 2013 and almost 8,000 are orphans or vulnerable children because of AIDS.

One of the consequences of the silence weighing on these children is that their access to antiretroviral treatment is more limited than adults.  Despite free treatment since 1997, three quarters of adults in need benefited in 2011 in contrast to only one third of children, according to CNLS.

Since 2010, reimbursement of transport expenses for guardians taking children to medical appointments has reduced the number of children “falling off the radar,” says Mbaye Mboye.

“Children tend to be neglected compared with the global approach to caring for adults,” he laments.

HIV positive children have specific needs of school and nutrition support.  Absenteeism as a result of recurrent illness results in critical educational delays and malnourishment is higher among them.

Ibrahima Ba, secretary general of RNP+, points to the economic situation, the lack of co-ordination between health staff and social workers, and the absence of a national programme specifically for children.

“Children are left high and dry,” he says. “It is the mother’s responsibility to take the child to hospital, and she only goes when the child is ill.  If it is a minor problem, she downplays it.”

Senegal has only 59 paediatric units providing care for HIV positive children compared to 97 for adults.

“There is no follow up on children who do not come regularly to hospital, no one calls the guardian,” adds Ba. “The state needs to focus more on children living with HIV because they are becoming sexually active teenagers.”

The reduction in international funding for AIDS is of concern to the National Alliance against AIDS (ANCS).

“We are concerned that the state is no longer taking charge and we are afraid the gains achieved in 25 years of fighting AIDS may be reversed,” says Massogui Thiandoum, head of programmes at ANCS.

Edited by: Mercedes Sayagues

Translated by: Runyararo Bertha Faranisi 

Chifundo ART Clinic in Lusaka. Credit: AHF

By Chisha Mutale
Lusaka, Jul 28 2014 (IPS)

Chisha Mutale reports from Lusaka that substantial progress has been made against the transmission of HIV from mother to child by the the Zambian government and its cooperating partners.

[podcast]http://traffic.libsyn.com/ipslatamradio07/zambia_PMTCT.mp3[/podcast]

Bosena, 25, sits on the side of a busy road in Addis Ababa, Ethiopia’s capital, with a baby in her arms. Ethiopia is among the countries listed as having made significant progress in reducing child and maternal mortality rates. Credit: Jacey Fortin/IPS

By Nqabomzi Bikitsha
JOHANNESBURG, Jun 30 2014 (IPS)

Every year, three million newborn babies and almost 6.6 million children under five die globally, but if the rest of the world looked towards the examples of two of Africa’s least-developed countries (LDCs), Rwanda and Ethiopia, they would perhaps be able to save these children.

At the 2014 Partners’ Forum being held in Johannesburg, South Africa from Jun. 30 to Jul. 2 – hosted by the Partnership for Maternal, Newborn and Child Health (PMNCH), the South African government and other partners – significant commitments in finance, service delivery and policy were announced that could put an end to these deaths. In total, there were 40 commitments from stakeholders, governments and the private sector who are committed to ending child and maternal mortality were revealed at the forum today.

It was noted that while remarkable progress has been made in reducing maternal and child mortality rates globally, over the last two decades the reduction in the rates of newborn deaths has lagged behind considerably.

However, Rwanda and Ethiopia were among 10 countries across the globe listed as having made significant  progress in reducing child and maternal mortality rates, according to a new global action plan launched at the forum.

The Every Newborn Action Plan (ENAP) provides evidence on the effective interventions needed to end preventable stillbirths and newborn deaths. It also outlines a strategy to prevent 2,9 million newborn deaths and 2,6 million stillbirths annually.

These countries invested in high-impact health interventions, including immunisation, family planning, education and good governance.

Tedros Adhanom Ghebreyesus, Ethiopian Minister of Foreign Affairs, told IPS that multi-sectoral investments, and not just direct investments in the health sector, would help reduce maternal and child mortality.

“If we don’t invest in agriculture, water and sanitation as well as the health sector then any gains we make in reducing child and maternal mortality will be futile.

“Community-based health care workers helped reduced Ethiopia’s mortality rates for mothers and children.”

According to the ENAP, newborn deaths account for 44 percent of all under five deaths worldwide, and investments in quality care at birth could save the lives of three million women and children each year.

“Now is the time to focus on action and implementation, to ensure more lives are saved,” said Graça Machel, co-chair of the PMNCH.

“Other countries have made progress and others have not, we need to learn from them, so we keep momentum.”

Accompanying the launch of the ENAP, was the launch of Countdown to 2015 report titled “Fulfilling the Health Agenda for Women and Children”, which serves as a scorecard of gains made in maternal and child health.

According to the report, which studied the progress of 75 countries in child and maternal mortality efforts, substantial inequities still persist.

“The theme of the Countdown report is ‘unfinished business,’” said Machel. “Too many women and children are dying when simple  treatment exists.”

Over 71 percent of newborn deaths could be avoided without intensive care, and are usually a result of three preventable conditions; prematurity, birth complications and severe infections.

Dr. Mariame Sylla, United Nations Children’s Fund (UNICEF) regional health specialist, told IPS that countries needed to learn from one another.

“Community-based approaches, where governments bring health services to the people and people to the services, have shown to be effective,” she told IPS.

“Monitoring of results is also very important to ensure accountability in the health sector.”

Dr. Aaron Motsoaledi, South Africa’s Minister of Health, said “having professional midwives would also help new mothers understand motherhood better and help reduce mortality rates among women and children.”

However,  Ethiopia’s Minister of Foreign Affairs pointed out that “these  efforts are are simple but often hard to deliver.”

“Least-developed countries like Ethiopia were able to make strides in curbing child and maternal mortality through their political will,” Dr. Janet Kayita, health specialist for maternal, newborn and child health for UNICEF, told IPS.

But she pointed out that “Ethiopia’s key to success, was not just about the leadership making the decision to reduce child and maternal mortality rates, but also organising at community level.”

“Ethiopia is one of the few LDC’s to institutionalise quality improvement in the health sector, using the mechanism of rewarding good quality health services and holding accountable those not performing.”

According to an African proverb, “every woman who gives birth has one foot on her grave.” It is time to make this proverb a historical fact and not a present reality. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Jun 27 2014 (IPS)

An African proverb says that every woman who gives birth has one foot on her grave.

Sadly, this is still true today, especially within the context of the AIDS epidemic.

In spite of the huge advances in the prevention of mother to child transmission of HIV (PMTCT) in Africa, experts are concerned that these have not matched other pillars needed to eliminate maternal mortality caused by HIV and AIDS.

Preventing unintended pregnancies among women living HIV, as well as providing contraceptives for women who need them are some of the missing pillars. Another is making motherhood safer for all women.

Pregnant women with HIV die at much higher rates than women without HIV, Mary Pat Kieffer, senior director at Elizabeth Glaser Paediatric AIDS Foundation in Malawi, told IPS.

The risk of pregnancy-related death is six to eight times higher for HIV positive women than their HIV negative counterparts.

Studies have shown that HIV increases maternal mortality directly from the progression of the HIV disease itself, and indirectly through higher rates of sepsis, anaemia and other pregnancy-related conditions.

This is bad news at a big scale. In South Africa alone, up to 310,000 HIV positive women gave birth in 2012, and 110,000 in Mozambique, says the Joint United Nations Programme on HIV/AIDS (UNAIDS).

While all HIV positive women, whether on antiretroviral therapy (ART) or not, are more vulnerable to sepsis and anaemia because of their compromised immune system, Kieffer says that ART does boost the immune system that protects women from infections.

Another problem is that women become infected with HIV during pregnancy at higher rates compared to women who are not pregnant, alerts Kieffer.

Experts attribute this to biological changes in the woman’s reproductive tract, including the increased blood volume and hormonal changes.

In southern African countries, “as many as five percent of pregnant women who tested HIV negative during their second trimester of pregnancy become infected with HIV later in pregnancy or during breastfeeding,” Kieffer told IPS.

Rethinking PMTCT

While ART for prevention of mother to child transmission of HIV is key to reducing maternal mortality, “fighting HIV is about more than pushing ARVs into health systems,” says Kieffer.

In South Africa, where nearly two out of 10 persons aged 15-49 are HIV positive, in spite of universal PMTCT coverage, HIV still accounted for six out of 10 maternal deaths in 2012, according to UNAIDS.

In Lesotho, with an HIV infection rate of 23 percent, four out of 10 maternal deaths are attributed to HIV related complications. In Malawi it is three maternal deaths out of ten, with an HIV infection rate of 11 percent.

Naseem Awl, an HIV specialist with UNICEF in Lesotho, told IPS that “much work remains to be done besides the provision of medicines, and one is ensuring women deliver in a health facility.”

UNICEF statistics show that in Eastern and Southern Africa only four out of 10 pregnant women deliver their babies with the assistance of a skilled health professional.

In Lesotho, while nine out of 10 pregnant women attend at least one antenatal visit, more than half do not deliver in the care of a skilled birth attendant. Mozambique has a similar pattern – and up to 110,000 HIV positive women gave birth here in 2012.

Kieffer believes there is a need to rethink PMTCT, “not just as a way to keep the infant from acquiring HIV but as an essential part of maternal and child health care for all women.”

Sheurges an improvement of health services delivery and health staff attitudes.

“A good number of health workers believe that HIV positive women have no right to get pregnant,” she says. The consequence is that many women show up late for antenatal care or deliver at home.

Protecting young women

Addressing unwanted pregnancies among young women aged 15-24 years is yet another pillar, because they are two to four times more likely to be infected with HIV than men of the same age.

The highest incidence for HIV lies in the 19-24 age group, “when people are sexually active and may not have a single partner. It is also when most women become pregnant for the first time,” says Kieffer.

The two major causes of death for young women are complications of childbirth and HIV, according to the United Nations Population Fund. Because their bodies are not fully mature, they experience more problems with a pregnancy and are at higher risk of HIV infection.

“Young women lack experience with the health system, they may discover their pregnancy late and be afraid to go to the clinic,” Kieffer explains. “They are less emotionally mature and less likely to have a partner that they can rely on for emotional support, either for the pregnancy or the HIV.”

She adds that health workers may not treat young women with care or lack the time to give the extra attention, information and support they need.

Meanwhile, staggering needs for contraceptives present other challenges. In Lesotho, the unmet need for family planning is 23 percent. In Mozambique, 29 percent, says UNAIDS.

Even where contraceptives are available, “ART clinics are overcrowded and overwhelmed, and have resisted putting emphasis on family planning because they did not have the capacity,” says Kieffer.

Dr Chewe Luo, senior adviser on HIV at UNICEF, told IPS that the new ART involving only one pill per day for pregnant women living with HIV will “have a serious impact on AIDS-related maternal and child deaths.”

In addition, the integration of maternal and child health services will result in more women and children reached sooner, and more mothers’ lives saved, she told IPS.

By strengthening all the pillars needed to improve maternal health, the African proverb about mothers having a foot on their graves will become history instead of a grim reality.

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