Africa News

Archive for the ‘HIV’ Category

JOHANNESBURG, 26 January 2010 (PlusNews) – The announcement in late 2009 that the government had approved a new HIV/AIDS policy in the South African National Defence Force (SANDF) was widely welcomed by AIDS and human rights lobbyists as long overdue.

A November 2009 statement by the SANDF noted that the new policy made provision for the “recruitment and selective deployment of HIV-positive members” of the military and complied with a High Court ruling in May 2008, which found the previous policy of excluding HIV-positive people from recruitment and foreign deployment unconstitutional.

The South African Security Forces Union (SASFU) assisted by the AIDS Law Project (ALP), had brought a case to the High Court on behalf of two of its members who were denied employment and deployment opportunities because of their HIV-positive status.

The SANDF’s surgeon general, Lt-Gen Vejaynand Ramlakan, said the military had been in the process of reviewing its HV/AIDS policy long before. He noted, however, that the particulars of the new framework remained classified, although parts of it were “in the public domain” and already being implemented.

“The reason [the new policy] has taken so long is that we’re dealing with the stigma and fears that surround HIV and AIDS,” he told IRIN/PlusNews. “Military people share all the misunderstandings of wider society. We needed to consult very widely with all military commanders and to convince them of the need to change the existing policy, and to prevent any misunderstanding about whether combat readiness would be affected.”

Other southern African defence forces and the UN Department of Peacekeeping Operations also had to be consulted, as well as the South African National AIDS Council. The new policy also had to ensure that “the health standards of the SANDF are commensurate with the tasks they have to perform.”

In the past, military policy-makers argued that the tasks armies had to perform took precedence over the individual rights of people living with HIV and AIDS, and that the demands of foreign deployment and combat could jeopardize the health of an HIV-positive soldier and that of his colleagues.

These arguments have carried less weight since antiretroviral (ARV) therapy turned HIV into a chronic, manageable disease.

Implementing the policy

A draft of the new policy, obtained by ALP, draws on a system of classifying soldiers according to their health status and needs.

An HIV-positive soldier who is stable and asymptomatic can now be classified as a “G2K1″, meaning they have a chronic but treatable disease and can be deployed “anywhere at any time”.

However, if HIV-positive soldiers are to be deployed abroad they must have a CD4 cell count [a measure of immune system strength] higher than 350, and an undetectable viral load [the amount of HI virus in the blood]. The ALP pointed out that this excluded anyone not on treatment, as only ARVs could reduce the viral load to undetectable levels.

S’khumbuzo Maphumalo, an ALP attorney, described the requirement as not reconcilable, with an emphasis on non-discrimination of asymptomatic HIV-positive individuals. “The way we see it, someone who has a very high CD4 count is unlikely to fall ill,” he told IRIN/PlusNews.

An HIV-positive recruit is also required to be on ARVs for three to six months before being considered for deployment, and failure to adhere to treatment is grounds for being declared “temporarily unfit for deployment and military courses”.

Ramlakan confirmed that a soldier would have to be on ARVs to qualify for foreign deployment, but declined to discuss the rationale for such a provision. He also noted that personnel with higher health classifications would be given preference for foreign deployment.

The only HIV-positive soldier known to have been deployed abroad is one of the applicants in the court case brought by SASFU, Sergeant Sipho Mthethwa, an operations planner sent to Sudan for six months in October 2009.

On his cell phone from Darfur, in western Sudan, Mthethwa said he was “very, very happy [about the new policy]. Now I feel that I’m a full member of the SANDF because I do everything that other people are allowed to do.”

He claimed he was still treated unfairly by his superiors. “They just want to make sure that I get demoralized, or I quit, or I get sick. Hopefully that’s not going to happen,” he told IRIN/PlusNews, adding that he was fit and taking his daily ARV medication.

Ramlakan said a campaign to inform unit commanders and health workers about the new policy was underway, but Dan Mthembu, of SASFU, told IRIN/PlusNews that his union had yet to see the policy, or have the opportunity to ensure it was properly implemented. “We need to sit down and work together, but we’ve been excluded from the process of implementation.”

This study is being led by Dr Cindy Firnhaber, an HIV physician with over 15 years experience in HIV and AIDS care both in America and South Africa. Firnhaber is now working with the government to develop a cervical cancer screening programme for HIV-positive women. Her study, which started four years ago, involves 2000 women attending the Right to Care Thembalethu AIDS Clinic at Helen Joseph Hospital, in Johannesburg. Interim results suggest that a significant number of them could develop cervical cancer or cancer of the cervix.

“Over 1000 of them have early changes that could lead to cervical cancer. It doesn’t mean they have cervical cancer, but they have early changes. That’s quite a few – that’s 1 in 2. We want to treat those women early to get those changes out before they progress to cancer. And about 300 – 400 of those women have changes that are pretty significant – that if we don’t take them out now they could in a year’s time, maybe, develop into a cancer, or longer, it’s hard to know. But it’s very important that we get those abnormal cells out now”, she explains about the finding.

“We are seeing much higher rates of pre-cancerous lesions or early cancers. We’re seeing higher rates of actual cervical cancer also. And then, we’re beginning to see that these women – which is something we’ve known – don’t clear the virus as well, their bodies are not able to repair these abnormal cells as well as a woman without HIV”.

“We are seeing rates between 200 – 300 women per 100 000 women, which is quite high. It’s much higher than… like in the United States, per se, where we are seeing about 7 – 10 per 100 00. So, we are seeing a significant increase in cervical cancer, here. Part of that is due to more the HIV epidemic and part of that is due to the access to screening… it’s not as available. General figures for the women in South Africa has been about 30 – 40 per 100 000”, Firnhaber adds.

But why are HIV-positive women more likely to develop cervical cancer?

“Cervical cancer is caused by a sexually transmitted virus called Human Papilloma Virus (HPV). We do know that the lower the CD 4 count or the weaker the immune system, the more likelihood that women who have been exposed to HPV virus are going to maintain that virus in the cervical area”.

“They’re not able to clear the virus as well, like when you get a cold and you have a normal immune system, you’re able to clear the virus. But with your immune system being weakened, you don’t have the strength in your immune system to clear the virus. And once this virus incorporates itself into the DNA or the cervical cells, it’s more likely to change the cells to become pre-cancerous lesions and go on to cancerous lesions”, she explains.

The study was approved by Wits University’s ethics committee and is due for completion next April.

 

MAUN, Small charter planes fly tourists from all over the world to safari camps in Botswana’s Okavango Delta, where they view wildlife by day and pay up to US$1,000 a night to stay in luxury lodges or rough it in five-star tents.

The safari camps are mainly expatriate owned and managed, but guests are waited on, cooked for and guided through the bush by people from Maun, the largest town in the district and the gateway to the Okavango. After the government, safari camp operators are the biggest employers.

Most of the camps are only reachable by air, so employees spend three months at a time in the bush, working and living together. Many are young and single, while those who are married are rarely employed as couples and usually leave their spouses behind in Maun.

In other parts of the world, after-hours boredom would not be considered a dangerous occupational hazard, but this is Botswana, where one in four adults is infected with HIV.

“Let’s say a camp has 12 staff and you’re there for three months. You finish work and it’s boring and it’s quiet,” said Bonti Botunile, a relief manager who has worked at a number of safari camps. “People are social creatures; they’re going to get together and then break up and move on, and some won’t disclose their [HIV] status because they fear rejection.”

Companies have to foot the bill for HIV/AIDS-related absenteeism; sick employees must be flown out and relief workers flown in. A few years ago, safari camp operators began waking up to the fact that HIV/AIDS was bad for business.

“A lot of people died, a lot had to be flown to hospital; they were constantly having to retrain,” said Botunile. “They realised that if we don’t do something, our businesses are going to suffer.”

A number of the companies met with local health authorities to form a committee that now meets every two months to coordinate HIV/AIDS programmes for camp employees.

“Companies do their best”

The companies pay the costs of regularly flying doctors, nurses and counsellors from the Maun District Health Team into the camps to attend to staff members’ health needs and to conduct voluntary counselling and HIV testing. Many companies also employ full-time welfare officers and have a nurse on call to provide medical advice.

Before becoming a welfare officer for A&K Safaris, Mary Hastag worked for 10 different safari camp operators between 2004 and 2006, providing HIV/AIDS education. “At the time, there wasn’t much happening, but now most companies have workplace policies, welfare officers and lay counsellors. It’s a big improvement,” she told IRIN/PlusNews.

”A lot of people died, a lot had to be flown to hospital; they were constantly having to retrain.”
Lecco Masoko, a welfare officer and AIDS councillor for a company that operates three camps in the Okavango, gives employees information on how to stay healthy and encourages them to be tested. “By October last year, virtually all of our staff knew their status,” he said.

Although he knows that about 36 percent of employees are HIV positive, he doesn’t know an individual’s status unless they decide to disclose it, but said many employees were open about being HIV positive.

“People tend to be more open about their HIV status in the camps than they are in town,” commented Allison Brown, a nurse contracted by 25 safari operators to provide medical advice and evaluations.

By special arrangement with Maun Hospital, camp employees who are on antiretroviral (ARV) treatment and have been declared stable by a doctor can pick up a three-month supply of the drugs when they come home on leave, but Brown said the HIV/AIDS clinic at the hospital did not always have enough stock to give them medicine for three months at a time.

Hastag said the safari operators’ good intentions often came up against the limitations of the local public health service. “There’s a shortage of medical staff and drugs, so even if the companies do their best, at times the District Health Team doesn’t go to the camps every month because of staff shortages.” February was one such month, when A&K had to fly employees in need of medical attention to Maun.

According to Brown, newly arrived expatriate managers also sometimes lacked sufficient support and information to help them deal with HIV and AIDS. “Management is under a lot of pressure,” she said. “They’ve got busy lodges, guests who’re paying a lot of money, and staff who are sometimes sick.”

Behaviour change a challenge

Ensuring that HIV-positive employees receive all the medical care and healthy food that they need is one thing; making sure that HIV-negative employees stay that way is more difficult.

Male and female condoms are available at all the camps, and some companies have built sports fields and installed satellite television to combat the boredom factor, but convincing employees to change their behaviour is not easy.

Staff receive information about how to minimise their HIV risk, but “most are single, and there’s a habit of having one partner in camp and one in Maun,” said Hastag. 22 February 2008 (PlusNews)

JOHANNESBURG, More international aid has been dedicated to fighting HIV/AIDS than any other disease, but what impact have all those donor dollars had in countries where HIV/AIDS funding often exceeds total domestic health budgets?

The three largest HIV/AIDS donors – the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the World Bank’s Multi-Country AIDS Programme (MAP) – have spent US$20 billion on combating AIDS since 2000.

But a new report by the Washington-based Centre for Global Development, “Seizing the opportunity on AIDS and health systems”, launched at the International AIDS Conference in Mexico City last week, suggests that AIDS donors may actually have weakened the health systems necessary for an effective AIDS response.

“The big HIV donors are creating AIDS-specific systems that compete for health workers and administrative talent, share the same inadequate infrastructure, and further complicate already complex flows of information,” said Nandini Oomman, lead author of the report.

Noting that “The future of the global HIV/AIDS response cannot be considered independently from that of national health systems,” the study examined interactions between the three donors and health systems in three countries where they work: Mozambique, Uganda and Zambia.

”The future of the global HIV/AIDS response cannot be considered independently from that of national health systems”
Focusing on three components of those health systems – health information systems, supply chains for essential drugs, and human resources – the researchers found that donors had developed AIDS-specific processes, often creating a drain on resources essential to the country’s broader health system.

In the area of health information systems, for example, all three donors have their own reporting requirements, which burden already overstretched health facility staff with multiple record-keeping duties. “This extra effort takes away time from helping AIDS patients or providing other health services,” Oomman pointed out.

With the goal of distributing antiretroviral drugs more efficiently, donors have also supported the development of procedures that are separate from those for other essential medicines.

The report warns that “As antiretrovirals come to be offered at more and more facilities, maintaining the separate systems will become increasingly complex,” and recommends integrating the two systems.

All three countries covered in the report are experiencing severe shortages of qualified health workers, but instead of training additional workers, the three donors have funded specific training in HIV/AIDS for existing staff. In some cases, they have rewarded staff for the extra work administering their programmes with salary top-ups.

“Such top-ups … focus the attention of clinical staff on HIV/AIDS – in some cases reducing the time they give to other health services,” the report’s authors argued.

PEPFAR has also funded the hiring of large numbers of non-governmental organisation (NGO) health workers, who often earn significantly more than their counterparts working for the state. A clerk working for a PEPFAR-funded programme in Zambia, for example, makes about twice as much as a registered nurse in the public sector, according to the study.

Not surprisingly, donor funding for better paying jobs with NGOs has sometimes pulled desperately needed staff away from the state sector.

The report concludes that donors should shift their response from an initial emergency mode, in which they circumvented weak areas of national health systems to set up systems that could achieve quicker results.

15 August 2008 (PlusNews) –

KITUI, When Mary Muli and her husband failed to conceive a child, they followed the long-held tradition among the Kemba in Kenya’s Eastern Province and brought another woman into their home to bear children for them.

“We were married for 30 years when we realised we would die without children,” Muli, 60, told IRIN/PlusNews from her home in Kitui District. “I brought Teresia to bear us children and to one day remain behind when we are all gone.”

The four children Teresia Nthenya, now aged 38, bore for the couple are considered to be Muli’s. “She is my property and my husband’s duty was only to bear children with her,” Muli said.

Although the arrangement is considered successful because of the children, it has had disastrous consequences: Nthenya is HIV positive, while Muli’s husband died 18 months ago from tuberculosis, a common opportunistic infection associated with HIV. Muli herself coughs constantly, but brushes it off as nothing more than a symptom of old age.

“I used to sleep with him and he also slept with his real wife; we used no condoms,” Nthenya said. “I am HIV positive and I know I got it here, from the man.”

”I brought Teresia to bear us children and to one day remain behind when we are all gone”
According to Dr John Lugedi, the Kitui District medical officer, the tradition of surrogate wives is a significant contributor to the spread of HIV in the area.

“The risks of this kind of culture are very high because the people involved do not use condoms,” he said. “Men do not want to believe that it may be them with the [infertility] problem and they keep on [trying to have children with different women] hoping to be lucky some day. What you have is a chain of infected people in the process.”

He noted that the high levels of poverty in Kitui, where more than 60 percent of the population lives on less than US$1 per day, had allowed the practice to flourish. Women become child bearers, he explained, because they know that as long as they bear children, their basic needs will be met by the family they live with. “When you let poverty mingle with such risky cultures, the result can be very devastating in the war against HIV/AIDS,” Lugedi added.

“Most of the widows and orphans that we support in the district are from this kind of marriage arrangement,” said Liz Mwendwa, coordinator of a local NGO, Arms of Hope. “There is a need to concentrate awareness on the eradication of this practice or to look at safer ways of doing it, but I think it would be a daunting task to encourage condom use when the end goal is to have children.”

Although the HIV prevalence rate in Kitui of 3.9 percent is lower than the national average of 7.4 percent, the risk factors for HIV are high. Poverty and food shortages can drive women into commercial sex work, and the region’s arid climate forces many men to spend long periods away from home as migrant labour.
9 January 2009