Your daily Selection of IRIN Africa PlusNews reports, 3/5/2004

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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 - AFRICA: PlusNews Web Special - Gender and HIV/AIDS

2 - ANGOLA: Empowering girls at heart of AIDS strategy

3 - SWAZILAND: All about hope

4 - SWAZILAND: Unregulated ARVs cause health havoc

5 - ZAMBIA: The ultimate sacrifice

1 - AFRICA: PlusNews Web Special - Gender and HIV/AIDS

JOHANNESBURG, 5 March (PLUSNEWS) - PlusNews, IRIN's HIV/AIDS news service,

has launched a new Web Special to mark International Women's Day on 8

March 2004.

A series of features from Angola, Swaziland and Zambia examines the

connection between gender and HIV/AIDS. The Web Special also links to a

campaign by the UN's Regional Inter-Agency Coordination Support Office for

the Special Envoy for Humanitarian Needs in Southern Africa, which

explores the region's humanitarian crisis " Through the Eyes of Women " .

Kofi n, the UN Secretary-General, has highlighted the connection

between women's empowerment and the global response to HIV/AIDS.

" As AIDS strikes at the lifeline of society that women represent, a

vicious cycle develops. Poor women are becoming even less economically

secure as a result of AIDS, often deprived of rights to housing, property

or inheritance, or even adequate health services. In rural areas, AIDS has

caused the collapse of coping systems that for centuries have helped women

to feed their families during times of drought and famine - leading in

turn to family break-ups, migration, and yet greater risk of HIV

infection, " n said in a statement to mark this year's International

Women's Day.

" As AIDS forces girls to drop out of school - whether they are forced to

take care of a sick relative, run the household, or help support the

family - they fall deeper into poverty. Their own children in turn are

less likely to attend school - and more likely to become infected. Thus,

society pays many times over the deadly price of the impact on women of

AIDS, " he added.

The Web Special can be viewed at:

http://www.plusnews.org/webspecials/womensday/default.asp

[ENDS]

2 - ANGOLA: Empowering girls at heart of AIDS strategy

LUANDA, 5 March (PLUSNEWS) - One pristine building stands out along a

dusty street in the Angolan capital, Luanda.

With its sparkling tiles and laboratory technicians in spotless white

coats, the Centro de Apoio aos Juvens (CAJ), or youth support centre,

looks like a clinic, but the laughter and noisy debate sound more like a

youth club or boisterous classroom - in fact, it's a combination of all

three.

In Angola, where 60 percent of the population are under the age of 18,

teenagers shoulder a massive responsibility in helping to rebuild the

country after a devastating 27-year civil conflict. And it is the Angolan

youth who are again on the frontline in the battle against HIV/AIDS.

" We all need to be aware of what adolescents are doing. If it wasn't for

them, we would be steps behind in the fight against HIV/AIDS. They are the

best advocates, " said Luick, HIV/AIDS project officer at the UN

Children's Fund (UNICEF).

UNICEF partners the UN Population Fund (UNFPA) in running this centre, 10

others in Luanda and another nine in the southern provinces of Benguela

and Huila, where youngsters aged 10 to 24 are tested for sexually

transmitted diseases, including HIV/AIDS, and receive counselling.

The support programme does not stop there. " An important part of our

strategy is debate. We're not here to lay down the law, " explained Doctor

Isobel Massocolo Neves, one of four doctors who work at the centre.

" We adopt a peer group strategy, so we have youth talking to youth about

all kinds of issues – relationships, equality, safe sex, unwanted

pregnancies and general reproductive health, " she said.

Studies at the centres show there is an urgent need to encourage teenagers

to be tested; to equip them with the knowledge they need to protect

themselves, and remove some of the stigma surrounding HIV/AIDS.

Ironically, Angola's civil war may have helped curb the spread of the

disease, but with the end of the conflict allowing greater mobility, the

danger is that people are taking the virus with them.

Humanitarian organisations and NGOs have been saying for some time that

Angola must grasp this window of opportunity and prevent a leap in the

relatively low prevalence rate, which four-year-old figures put at 5.5

percent.

A low level of knowledge about the disease, coupled with a high fertility

rate – the average Angolan woman has seven children – create ideal

conditions for an epidemic on the scale of neighbouring Botswana, where

UNAIDS estimates that almost 39 percent of the population is infected.

Neves believes the rate in Angola is already climbing - figures from a

2003 survey by the US Agency for International Development, the US Centres

for Disease Control, Population Services International, the National AIDS

Control Programme and UNICEF would appear to reinforce her fears.

Of around 14,000 people tested for the disease at voluntary counselling

and testing (VCT) sites, a startling 10.4 percent were HIV-positive.

UNICEF's Luick acknowledged the numbers could be artificially inflated,

with many of those seeking VCT doing so because they suspected they might

have the disease - but they nevertheless illustrate a need to move fast.

The hope is that the young will create a virtuous cycle, helping to ease

the problem rather than exacerbating it. Changing the behaviour of girls

and their way of thinking form the crux of future strategy.

In the past, the ABC of HIV prevention – Abstinence, Be faithful and

consistent, and correct use of Condoms – was the message, explained

Antonica Hembe, national programme officer for UNFPA. " But now we're

moving onto D and E – Delay and Empowerment of girls, " she told PlusNews.

" If we can give girls alternatives - provide them with enough information

to make their own decisions, then they have a choice, " she said.

They will have their work cut out in Angola, where becoming a wife or a

mother is often considered the ultimate achievement; where it is not

uncommon for young girls to have sex as young as aged 14; and where women

typically give up the most for the good of the family.

" Girls in Angola, and across the region, are traditionally the first to

make sacrifices for the betterment of the family. That often means they

are the first to miss out on education; they are the most vulnerable; they

only look at their personal concerns once everyone else in the family is

taken care of, " said UNICEF's Luick.

Eighteen-year-old Vanya is an example: she is pregnant, thanks to a burst

condom, and has had to put her ambitions on hold. " I wanted to be a

doctor - then this happened, " she said, pointing to her bump. " At first I

was sad, but now I'm okay about it, and my boyfriend is helping. And I can

still be a doctor later, I'm sure. "

That Vanya now feels on an equal footing with her partner and, perhaps

more importantly, has not let go of her goal, indicate changing attitudes.

" When girls have dreams for the future, that changes the game. They stop

saying 'I want to have a baby by the time I'm 18, so I that have my place

in society as a mother,' " said Luick.

" That can change to 'Yes, I would like kids one day, but I want to do x,

y, z first.' It's not so much about their position in society as a wife

and a mother, it's about their own merit and doing something for

themselves, " she added.

As the 2003 survey showed, women are both more infected and affected by

the HIV/AIDS virus - of the 10.4 percent of people found to be

HIV-positive, more than two-thirds were women.

" There is this sense that somehow it is all the girls' fault: they are

associated with prostitutes and promiscuity, " said Luick.

" But the truth is, they're not having more partners; they're not having

more sex, but they are more affected because they are more biologically at

risk, and they live in a country where traditionally women don't have the

same opportunities as men. "

Neves argues that inspiring girls, who make up 86 percent of attendees at

the clinics, and changing the way they and their partners think, are key

objectives, but lack of funds may yet hamper their activities.

With adolescents' interest piqued by community-level youth centres, run by

UNICEF as part of the UN's " Telling The Story " programme, as well as a

twice-monthly national TV programme on the project, Neves hopes that

intense in-country fundraising and support by the Southern African Youth

Initiative for HIV/AIDS (SAY) will allow their work to continue and

expand.

" We try to be a motivation. In our society, girls don't have the power to

make decisions - women do what men say, " she said.

" We have more girls here because the men think reproductive health is the

sole responsibility of the woman. But now we're beginning to see that more

girls and boys are coming to the centre together, acknowledging that it is

the couple's responsibility.

" That's already a big improvement, but we have to keep working at this,

and for that we need more money, " she said.

For a series of Special Reports on Gender and HIV/AIDS by IRIN/PlusNews to

mark International Women's Day visit:

http://www.plusnews.org/webspecials/womensday/default.asp

[ENDS]

3 - SWAZILAND: All about hope

MBABANE, 5 March (PLUSNEWS) - Swaziland's most innovative and motivated

HIV/AIDS mitigation programme has sprung from five traumatised,

middle-aged HIV-positive women, and their efforts offer a blueprint for

coping with the epidemic.

" We call our group Swaziland Positive Living [sWAPOL], and it was forged

from the suffering our the founding members. That may be why people

respond to what we are doing, and we are getting so many requests to help

communities where HIV is rampant. We are not an NGO that works out of a

plush office. We are people who know what it means to face discrimination

and rejection, but who have the will to live, " founding member Siphiwe

Hlope told IRIN.

She spoke at the edge of an extensive field where vegetables are grown to

meet the nutritional needs of members living with HIV/AIDS, and which

generate income to sustain a host of projects. The farm itself is a

testament to the way the women's group has changed attitudes, as well as

prolonged lives.

In an extraordinary breach of custom, the 11-hectare farm at Mahlangatsha,

40 km southeast of the capital Mbabane, was given to the women by local

chiefs.

" Since time immemorial, only men have been given land by chiefs to

cultivate for their families. But the chiefs saw how we were helping their

communities, and we needed land to grow crops for our projects. This land

was their vote of confidence in us, " said Thelma Dlamini, who founded

SWAPOL, along with Hlope, Nonhlanhla Dlamini, Elina Hltatshwako, and Gugu

Mbata (who died last year).

All five women were HIV-positive; all had similar stories of rejection by

their loved ones when their medical condition became known in a country

where stigma still makes it difficult to admit one's HIV-positive status.

Hlope's experience was typical. " I wanted to continue my schooling. I was

39, and I had studied in Zambia from 1995 to 1998. It was all set that I

get a scholarship, but a requirement was that I take a blood test. The

results came back that I was HIV-positive. I was denied the scholarship. I

was terribly disappointed, and I also had to understand the medical news, "

she explained.

" I went to tell my husband I was HIV-positive. We were at home, in the

bedroom - we were just sitting and chatting. He asked me about school,

because I was supposed to leave the next month. I told him I was no longer

going; I told him why. There was a dark cloud inside that room.

" I really needed his love and support, but he said, 'If you are

HIV-positive, that means you are the one who has come home with the

disease, because you were out of the country for a long time.' He blamed

me, " said Hlope.

" I never had an affair - he was trying to shift the blame from him to me.

In the morning, he went to work without talking to me. He wouldn't eat the

breakfast I prepared for him. He came in the evening, and he told me he

was moving out. It was no answer if he was trying to escape HIV. He was

just going to spread it by infecting others. "

The five HIV-positive women from the rural area of Makanyane somehow found

each other, despite an absence of HIV/AIDS support groups outside urban

centres. As they shared their experiences, they decided it was time to

act.

" We thought, 'Why can't we form an organisation for the women living with

HIV/AIDS, so we can share our experiences, and educate our families?' "

said Hlope. " We called ourselves Swaziland Positive Living, because life

goes on even if you are HIV-positive. "

SWAPOL was set up as a cooperative where members volunteer on

income-generating projects. Half the profits are used to recapitalise

projects, 25 percent is shared among the members, and the remaining 25

percent goes directly to HIV-positive people or AIDS patients in need of

assistance.

The group has a sewing project, making school uniforms and tracksuits for

schools that work with SWAPOL. The big farm at Mahlangatsha, about to

yield its second harvest, provides food for child-headed households who

have lost their parents to AIDS, while also producing vegetables for sale.

The women are encouraging HIV-positive people to establish small gardens

next to their homes. Though measuring only three metres by one metre, the

gardens can be managed by children or an ailing person, who often find

that leaving their sickbed to do a little watering is therapeutic.

To get the project off the ground, the women approached the UN Children's

Fund (UNICEF) in Swaziland in 2001, and won the support of the agency's

representative, Alan Brody.

" These were rural, middle-aged women who wanted their own support group.

At that time, at least 150,000 to 200,000 people were living with HIV,

mostly unknowingly. We felt every community needed a support organisation,

and we decided to give them some help by sponsoring information workshops

in their areas, to get them going. It's like venture capital - you try to

get something going because you think it has promise, " Brody recalled.

From the initial meeting of three women at the UNICEF office, SWAPOL today

has 400 members, including 50 men, in nine communities. " We open up our

membership to anyone. Those who are HIV-positive are 250. The others are

those who are affected by HIV, like parents who say their children are

HIV-positive, " said Hlope.

Fifty to 100 people usually attend SWAPOL community meetings. At a

gathering IRIN attended in a church at Sibovu, 80 people were being

instructed on how to stay healthy and active while HIV-positive. Many

middle-aged parents had children who were HIV-positive, and their

apprehension was apparent, but the listeners were assured that the virus

was not an immediate death sentence.

The topic of stigma and discrimination was also broached, and attitudes

about traditional Swazi life were addressed. SWAPOL is against polygamy,

which is legal in a country ruled by a king with eleven wives, because of

the risk of spreading HIV.

After the meeting, some community members privately told SWAPOL

representatives that they were HIV-positive, and asked for nutritional

information and other assistance. Some people wanted to have a blood test

arranged.

With growing funding from non-governmental sources and its own projects,

SWAPOL has trained 30 caregivers and 30 counsellors to work in their

communities. The caregivers assist with the material needs of families

affected by HIV and AIDS.

" The counsellors are trained and busy, because more and more children are

taking care of parents. They see their mothers dying, their fathers are

dying. The counsellors talk to them. They assist people to learn their HIV

status, communicate it to their loved ones, and give them advice on how to

live, " said Hlope.

" We are all about hard work, and hope. We are examples ourselves that if

you are HIV-positive, you don't just curl up and wait to die. Life goes

on, and there is no reason to be afraid, " she said.

In a country with the world's second highest HIV-infection rate - close to

40 percent - and persistent denial about the disease, it is a message that

needs to be heard.

For a series of Special Reports on Gender and HIV/AIDS by IRIN/PlusNews to

mark International Women's Day visit:

http://www.plusnews.org/webspecials/womensday/default.asp

[ENDS]

4 - SWAZILAND: Unregulated ARVs cause health havoc

MBABANE, 5 March (PLUSNEWS) - After years of resisting the introduction of

antiretroviral drugs (ARVs) in Swaziland, the government bowed to pressure

from international donor organisations last year and permitted their

distribution.

However, what followed has been a confusing and dangerous free-for-all

which has reached the point where some activists have called for the drugs

to be banned.

In some cases pharmacies are dispensing ARVS without prescription or

instructions informing patients of how to take the medication, and no

warning of possible side effects.

" There are pharmacies in Mbabane that sell ARVs to anyone coming off the

street. They do not dispense instructions, because the queue of people

wishing to buy [the drugs] is so long, " Siphiwe Hlope, co-director of the

AIDS support group Swazis for Positive Living, told IRIN.

" We concur with government's policy to permit ARVs, but a law regulating

their distribution is needed - anyone can sell ARVs. Taxi drivers going to

clinics to pick up ARVs for people get an extra supply, and they sell them

to passengers, " Hlope said.

AIDS activists have expressed concern that the lack of guidance in taking

ARVs had led to patients starting a treatment regimen and then stopping,

risking treatment resistance and further endangering their lives.

" People are not told to expect side effects. When they become nauseous,

dizzy and develop flu-like symptoms, which is to be expected with ARVs,

they tell us they stop taking the pills because they think they are

poisoning them. Once the regime of taking the medicine in proper and

regular doses is broken, it cannot be effectively renewed, " said one

health worker.

Widespread claims for AIDS cures published in the local press are also

causing alarm among health workers. Advocates of such cures usually insist

they are better than the " unsafe " ARVs.

Hannie Dlamini, president of the Swaziland AIDS Support Organisation

(SASO), has come out against the government's policy in promoting ARVS.

" These drugs are not the way to go - the only reliable treatment is the

adoption of a healthy diet, which entails eating mostly vegetables such as

spinach and sweet potatoes, " he said.

An international aid worker told IRIN: " People are confusing nutrition

with medicine. These should go hand in hand: nutrition to boost bodily

strength, and ARVs to counter HIV. "

But the problem in Swaziland is that some nutritional products are being

advertised and sold as " treatments " , or even as " AIDS cures " .

When contacted, the ministry of health said a statement would be prepared

to address the improper distribution of ARVs.

Dr Kunene, principal secretary at the health ministry, noted in a

recent statement: " There is no known cure for AIDS. People seeking

over-the-counter treatments must consult their physicians. "

UNAIDS estimates that 38.6 percent of adult Swazis are HIV positive. The

National Emergency Response Committee on HIV/AIDS, set up by government to

dispense United Nations Global Fund grants to local programmes dealing

with the disease, said half of people in their twenties were HIV positive.

[ENDS]

5 - ZAMBIA: The ultimate sacrifice

LUNDAZI, 5 March (PLUSNEWS) - The Zambian government's antiretroviral

(ARV) drug programme has managed to provide cheap, life-prolonging AIDS

treatment, but many HIV-positive Zambian women, denied access by a

tradition of subservience and sacrifice, are not benefiting.

Last year the government made available over US $2 million for the

purchase of 10,000 doses of ARV drugs. The Geneva-based Global Fund gave

Zambia a further $42.5 million to boost government efforts in the fight

against HIV/AIDS, tuberculosis and malaria.

Before the ARV rollout last August, combination AIDS therapy typically

cost around Kwacha 300,000 (US $63) per month, a colossal amount in a

country where 80 percent of people earn less than a dollar a day.

About 5,000 people - of a targeted 10,000 - have now qualified for the

subsidised programme, with each paying around $8 for a four-week course of

medication, delivered through the public health system.

A National AIDS Council report shows that of the 870,000 HIV-positive

Zambians, 70 percent are women. But that gender ratio is not reflected in

the statistics of those receiving ARVs. Instead, the majority enrolled in

the programme appear to be men.

In Petauke, a small rural town in eastern Zambia, for example, of the 40

people who are receiving ARVs, only three are women. Dr Muchango Siwale,

who works at the local hospital, is perplexed. Although fewer women than

men come into his surgery, " a lot more than three should be on treatment. "

While it is generally difficult for rural people to access decent and

timely health care, it is doubly difficult for women, who are more often

poor, voiceless and defer to customs that expect them to sacrifice for

their families.

The problem, says Siwale, is that women traditionally try and ignore their

health needs. " Women do not know their own value. They are real beasts of

burden. They get sick but, as long as they are able to pick up a hoe and

till the land, they carry on till they drop dead. "

His assistant, nurse Alyce Banda, also blamed the expectations heaped on

women if they are to be considered " good " wives. " When last did elders or

even neighbours sit a man down and tell him to take his wife to the clinic

because she does not look well? And yet women are chastised by society if

they do not take their husbands to the clinic for the slightest ailment.

They are accused of trying to kill him. "

Banda, a midwife, said in her 10 years at the clinic she had seen women

bringing their husbands on wheelbarrows, bicycles and even on their backs,

like babies. But she has yet to see a man even offer the support of his

arm and bring his wife for treatment.

A group of women attending antenatal classes in Petauke frankly explained

that if they were HIV-positive, their husbands would be unwilling to spend

money on lifelong ARV treatment for them. They would rather divorce a wife

considered too " expensive " .

" When I am pregnant, my husband gives me money for transport to the clinic

and other things because he knows this will pass. He will not spend on

indefinite treatment for me. Anyway, as a family we cannot afford it, "

said Mwanida Phiri.

Like many in the group, Phiri believes the situation would be, somehow,

" different " if her children or husband were sick.

Traditionally women are taught that they should not be a burden to their

family. " How would I feel if there is no food in the house to feed the

children because the money has been spent on medication which is only for

me? " asked Agnes Zulu.

But it appears that the men in Petauke have no such qualms.

Harriet Munjira and her husband, Benson, are both HIV-positive. But as

they can only afford treatment for one person, naturally, Benson is

receiving the ARVs. " I can look after the children - she will have

problems. My family will take everything from her [due to inheritance

customs] if I die, and she and the children will just remain suffering, "

he explained.

He feels bad that they cannot afford the additional US $8 for his wife,

but is confident that " she will manage " .

" She is the stronger of the two of us. Look at me, " he said, displaying

his thin, gangly legs, " I am the one on drugs, but I am in bed - Harriet

is outside making a fire to cook food. "

Though Harriet does not dispute she is physically the stronger of the two,

she is not as healthy as her husband suggests. She also does not believe

women should always be the ones who sacrifice. " I have no choice but to

get up and do my chores, tend the needs of my husband, even though my body

is telling me to rest. "

Blinking back tears, Harriet says Benson has not changed in their 19 years

of marriage. He is still selfish.

" Why couldn't I have gone on the treatment? I am the one who tends to the

fields and looks after the children. Benson only came to me when he was

sick - he has not supported this family in the last 12 years. As for the

property that his family is likely to grab - two small huts and a few pots

and pans - is that worth safeguarding? "

Still, she feels she cannot push the issue with the family elders. " People

will accuse me of wanting my husband to die ... that I should defer to

him, even though I am the one that has been holding this family together. "

Holder Chama, a single mother of five, has a different set of concerns.

She balked at taking her daily three-drug cocktail when she was told about

the importance of eating a balanced diet. Displaying the medicines still

tightly wrapped in her chitenge (traditional cloth) she said food was an

issue in her home.

" On most occasions we go without food ... as women, we eat last and there

usually is not enough to go around. So how can we go on the medication? We

need food to go with it. I tried to take the medication on a stomach full

of water and I vomited everything, " she said. Another time, after taking

the drugs she had such bad stomach cramps, she gave up.

Now she has left everything " in the hands of God " .

For a series of Special Reports on Gender and HIV/AIDS by IRIN/PlusNews to

mark International Women's Day visit:

http://www.plusnews.org/webspecials/womensday/default.asp

[ENDS]

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