Your daily Selection of IRIN Africa PlusNews reports, 5/28/2003

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U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network

CONTENT:

1 - BOTSWANA: Feature - A model for combating HIV/AIDS

2 - ETHIOPIA: Geldof launches HIV/AIDS appeal

3 - SWAZILAND: Anti-AIDS message reaches king's warriors

1 - BOTSWANA: Feature - A model for combating HIV/AIDS

GABORONE, 28 May (PLUSNEWS) - Botswana is the first country in Africa to

implement widespread distribution of antiretroviral (ARV) drugs through

its public health system under a programme aptly named 'Masa' ( " new

dawn " ), a symbol of hope for those living with HIV/AIDS.

The government's year-old programme has the financial support of the

African Comprehensive HIV/AIDS Partnership (ACHAP), a public-private

partnership with the Bill and Melinda Gates Foundation and the Merck

Foundation, as it tackles one of the highest HIV rates in the world.

Gloria Mmanekele Pilane is living positively with HIV and does her best to

help others through her work with the Centre for Youth of Hope. Three

years ago when she tested HIV-positive, she entered what she has described

as a carefree period, after being abandoned by her companion.

She has since learned to accept her status and recently confided in a Masa

newsletter " I have a condition, not a disease. It has a stigma attached to

it, but it's the same as someone having cancer, diabetes, high blood

[pressure] or arithritis. I therefore have to take extra care of myself

and eat properly. "

According to figures provided by ACHAP, approximately 300,000 people in

Botswana are HIV-positive, with an estimated 38.5 percent of the 15 to 49

age group infected. As a result, life expectancy will likely drop from 67

to 47 years by 2010, with an adverse impact on productivity gains in this

fairly prosperous " middle income " state.

A multi-sectoral response to the epidemic has seen a range of policies and

infrastructure adopted under the auspices of the National AIDS

Coordinating Agency (NACA), that reports directly to the president. The

aim is to have no new infections by 2016.

The Masa programme provides free ARVs and counselling at Gaborone,

Francistown, Serowe and Maun, targeting four priority groups of

HIV-positive people with CD4 (cells that orchestrate the body's immune

response) counts of less than 200: pregnant women, children older than six

months, TB patients and all adult patients with AIDS-defining illnesses.

Dr Ernst Darkoh, ACHAP operations manager of the Masa programme, noted:

" The progress is commendable because in one year we have created the

single biggest treatment center in the continent. " During this calendar

year, Darkoh added, the programme would be rolling out to nine additional

sites.

The ARV drugs cost the country between US $1,200 and $3,000 a year per

patient, with the additional cost of new clinic buildings and equipment

escalating the price to between $7,000 and $10,000 a year per patient. The

total cost for the first year was $30 million, a report by the Christian

Science Monitor said.

Merck has agreed to provide $50 million over five years to help finance

the project and has also agreed to " undertake " the provision of free ARVs,

according to the Associated Press. The programme is " beginning to make

headway " in treating HIV-positive people in the country, reducing HIV

prevalence among pregnant women from 36.2 percent in 2001 to 35.4 percent

last year.

ACHAP is supporting Masa by managing the recruitment and training of

health care workers, infrastructure, drug procurement and storage,

establishment of laboratory infrastructure - including a new $3 million

research laboratory where young scientists receive training - and

implementation of an IT system.

The Ministry of Health, with the assistance of ACHAP, implements and

manages the ARV programme.

But despite the existence of Masa, people are still reluctant to know

their HIV status, undermining government efforts to recommend ARVs to

those in need. According to official estimates, 110,000 people are

eligible for ARV therapy, but as of this month just under 5,000 were on

treatment.

" We have to convince people to be tested. Without that happening we cannot

reach people who need our services, " Darkoh noted.

" The main challenge is that people are coming forward very late. People

wait until they are deathly ill before they seek aid. It is a lot more

resource-intensive to treat people that are sick, and the burden on the

health system is much more difficult to manage. "

But ARV treatment is not just about distributing pills. " The reality is

that if people don't take them consistently they will develop resistant

strains to the virus, which will be immune to the systems we have, " Darkoh

commented.

Patients in the Masa programme have 90 percent to 100 percent drug regimen

adherence rates - as much as 20 percent higher than in the most successful

programmes in Western countries. Doctors attribute this to the intensive

counselling given to patients and the effectiveness of the drugs, the

Christian Science Monitor reported.

A survey conducted by NACA in 2002 to gauge the success of various

initiatives noted encouragingly that general awareness of HIV/AIDS was

more than 90 percent. In the 15 to 49 age group, condom use at last act

with a non-marital or non-cohabiting partner was 70 percent for women and

77.5 percent for men.

However, many people are still ill-informed about AIDS and therefore

vulnerable. Only about a third of men and 40 percent of women correctly

answered five questions about HIV/AIDS.

Nevertheless, Darkoh remains optimistic: " There is no cure for it yet, but

I believe there will be. "

[ENDS]

2 - ETHIOPIA: Geldof launches HIV/AIDS appeal

ADDIS ABABA, 28 May (PLUSNEWS) - The Irish rock star, Bob Geldof, on

Wednesday urged Ethiopia and its politicians to face up to the devastating

HIV/AIDS virus.

The singer and third world campaigner, now on his first official visit to

Ethiopia since Live Aid in 1985, said the virus was crippling the

impoverished country, and urged the population to stand up and acknowledge

the scale of the crisis.

" The situation here is catastrophic, " he said, pointing out that HIV/AIDS

together with massive debt and poor trade terms were debilitating the

country’s ability to fight drought. " This is really the equivalent of what

the bubonic plague did in Europe. It is devastating. You and your

economies cannot support this. "

Geldof came face to face with the impact of the virus by meeting a

10-year-old AIDS orphan, Meseret Tadese, who is one of three million

people in Ethiopia infected with the virus. The pair held hands in a tiny

mud shack in a shantytown on the outskirts of the capital, Addis Ababa.

" This girl wants to be a doctor when she grows up. Instead she will die

within a year, " said Geldof.

Families are too poor to buy drugs to treat the disease. " This is a

disgrace, " said Geldof. " This should not be happening in the world. "

He is looking to western governments to come up with a " Marshall Plan for

Africa " , with each of them pledging 0.16 percent of their GDP towards it.

[ENDS]

3 - SWAZILAND: Anti-AIDS message reaches king's warriors

MBABANE, 28 May (PLUSNEWS) - In a traditional kingdom that takes seriously

its customary social structures, the anti-AIDS message is this week being

targeted at young Swazi men belonging to King Mswati's warrior regiments.

" About 45 percent of Swazis in their twenties are HIV-positive, the

highest demographic group among an adult population that officially is

38.6 percent HIV-positive. Young men are the most vulnerable, " health

worker Mduduzi Simelane told PlusNews.

Simelane and health motivators from the Ministry of Health and various

NGOs are handing out AIDS literature, and dispensing advice on where to

get blood tests and counselling at a venue where this has never been

attempted: the warrior barracks at Mswati's royal village, Engabezweni.

Each May, the warrior regiments spend a fortnight at their traditional

compounds, rethatching beehive huts where they live, engaging in symbolic

tribute work like harvesting the king's sorghum field, and handing down

traditional skills like shield making and knob stick carving to younger

generations.

" Every Swazi, boy and girl, man and woman, belongs to the regiment of his

age mates. But lately we have grown alarmed by the decimation of what

should be the most vital of the regiments, the Inkhanyenti [swazi star,

the regiment of the king's sons], where the youngest warriors are

members, " said Balonja Mngomezulu, an elder from the Inyatsi (buffalo)

regiment.

Mgnomezulu will not specify the cause of the deaths - in Swaziland it is

still taboo to blame a fatality on AIDS because of the stigma attached to

the disease. But it is permissible to advocate ways to avoid the virus.

Mngomezulu and other warrior elders responded favourably to health

motivators' requests that they have access to the regiments when they

assembled for royal duties.

" We must educate these young men about AIDS, because they will listen to

us. What they hear at school does not have the same authority as what we

tell them, because we represent the king. When we speak to the warriors,

it is the king who appointed us who speaks to them, " one Inkhanyenti elder

explained.

The regimental leaders tell the warriors they must listen to what the

health motivators have to say. Because women are usually not allowed into

the warrior barracks, just as men are usually barred from the women's

regimental gatherings, male health motivators are pressed into service.

" Speaking to the young men is a matter of making them see the danger of

multiple girlfriends. That is what is spreading AIDS, the polygamous

mindset, " Aubrey Masuku, a community officer with the AIDS Information and

Support Centre in Manzini, told PlusNews.

" However, we are careful not to condemn polygamy, because it is legal in

Swaziland and a lot of the older warriors are polygamists. We have to

avoid antagonising anyone, " Masuku said.

Middle-aged warriors are also approached by health motivators, who engage

them in conversations about suspected AIDS-related deaths in their

communities. Older Swazis are vulnerable to HIV through the custom of

" kuteka " , where a widow enters the homestead of her late husband's brother

to become one of his wives. If the deceased died of AIDS, the disease can

affect a new family.

This month Mswati appointed as health minister a traditionalist, Chief

Sipho Shongwe. He is expected to ease the AIDS message into chieftaincies

where resistance to condom usage and blood testing is intense.

" Swaziland is largely a rural nation. Four out of five Swazis live in the

countryside under chiefs. So it is natural that the worst of AIDS can be

found in rural lands, " said Dr Kunene, the principal secretary in the

Ministry of Health.

Mswati has long advocated condom usage as a means of AIDS prevention.

Health motivators visiting the regiments this week carry with them cartons

of condoms for distribution.

" All the young men say they don't need a demonstration with our rubber

figures; they know how to use condoms. The challenge is actually

motivating them to do so, " said health worker August Malambe.

Malambe and his colleagues report that the warriors are receptive

listeners, and actually enjoy the diversion from wood gathering and water

fetching chores the elders have them do. " We don't lecture the boys, we

talk. We motivate, and the key motivation is to recognise the value of

life, and desiring to hold on to it, " Malambe said.

One sign that the message is getting through: As they parade in their

warrior finery, carrying cow-hide shields and wearing antelope loin skins

and pink regimental beads, young members of the regiments have added a new

touch to their fur anklets by inserting shiny gold condom packets that

reflect the sunlight - providing hope for an AIDS-free future.

[ENDS]

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