AfricaVox 2007

Reflecting on the G8's HIV promises

At the G8 in Germany our team of AfricaVox 2007 bloggers cast a critical eye over HIV promises made by the world’s powerful. Now they’re looking closer to home and discover that problems in the health sector require fresh thinking as well as new funds if they are to be solved.

As World Aids Day approaches Kakaire Kirunda, Zinhle Mapumulo, and Collins Vumiria explore teenage sex, whether traditional birth attendants could prevent positive pregnancies, rural progress and waiting lists that kill. 

These posts mark the final dispatches from the AfricaVox2007 bloggers. Thanks to everyone who has read, posted, praised and criticised. Panos London is now exploring the possibility of hosting a regular journalist blog - we will keep you updated.

Return to Mazista: a South African village recovers its health

Zinhle Mapumulo revisits a South African village in desperate need of health services and is pleasantly surprised.

Eight months ago, just before the G8 meeting in Germany, I visited the village of Mazista in the North West Province of South Africa and blogged about the stigma and fear felt there around HIV.

I described how villagers were too scared to disclose their HIV status and how the only easily accessible health service was a mobile clinic that visited twice a month.

A week after returning from Germany I received a call from the North West Department of Health inviting me to an open day in Mazista where they were planning to educate people about HIV and AIDS and voluntary counselling and testing (VCT).

Before I had a chance to accept, their media liaison asked me why I had to air their dirty laundry to the world. His question took me by surprise but made me wonder whether my article had anything to do with their invitation. I was told it was a coincidence.

I couldn’t make it to the open day and in any case I wasn’t sure it was worth travelling 300 km for what I believed to be a publicity stunt for the health department. To my surprise it was not.

The people of Mazista now have a mobile clinic that comes twice a week. Here they have access to testing and counselling for HIV. Some drugs not previously available, such as medication for tuberculosis, are also being delivered.

I learned this after a recent visit to the village, when once again I met Mmabo Lefatshe who had been so open about her HIV status and outspoken about the lack of services. She told me that some people in the village had been angry when they heard from the health authority that their business had been told to the world, but she said they now understood.
Lwandile Sicwetsha, health department spokesman told me Mazista had been identified as one of the priority areas for healthcare services in the province. “Home-based caregivers have been trained and are now working in the village and updating the ministry with information regarding health needs of people in Mazista,” he told me.

“Mobile clinics visit the area twice a week, but this is complemented by health programmes targeting the area with door-to-door campaigns and awareness campaigns on HIV and AIDS, pap smear and mental health.”

Good progress indeed. But even more could be done.

According to villagers the door-to-door visits happen once a month - not enough but better than nothing. However, the problem of access to antiretrovirals is yet to be addressed. Villagers still have to travel miles to get treatment.

And I am worried that people may not be taking advantage of the VCT being offered. The department could not provide me with data showing that people were utilising these services.

Things have definitely improved. But I suspect the final hurdle of overcoming stigma which prevents many from going for testing will take longer to surmount.

Uganda strives for a generation free from HIV

Kakaire Kirunda thinks the only way to stop the spread of HIV among teenagers is to treat them like adults.

Against a soothing instrumental background, a group of female friends discuss the hazards of sugar daddies on a popular Ugandan radio show:

Mary: Let me tell you about this friend of mine. A few months ago she told me mbu [that] she met this nice guy with a lot of money. Yes he was married but he treated her like a queen, took her to all the nice clubs, and bought her a really cool phone. Even the expensive clothes, he bought. Now yesterday she came to me crying, her world is falling a part. She has just found out that she is pregnant.

Kate: And the nice man?

Mary: He is not interested. He is tired of her. But that is not the worst part; she is also infected with HIV.

Kate: Girls! The gifts, the nights out, the cash, can never be worth your life and future. Older men are taking advantage of you and putting you at risk of HIV infection in exchange for these bu [small] things. This practice is called cross-generational sex. Respect yourselves, do what I do. Say no to sugar daddies…

Uganda wants an HIV-free generation and, to help to achieve this, the government has begun an onslaught against so-called cross-generational sex. The practice is defined as young people, especially girls, entering into sexual relationships with people who are more than ten years older.

Catchy as it is, I believe this media campaign is in danger of overlooking an inconvenient truth – young people are not contracting HIV simply because they have sex with older people, they are also at risk of transmitting HIV to one another.

Hard labour: stopping HIV in its tracks

Collins Vumiria discovers why Uganda’s traditional birth attendants are being sidelined in the fight against HIV.

Earlier this month I asked Uganda’s minister of state in charge of primary health care, Dr Emmanuel Otaala, why traditional birth attendants – who deliver tens of thousands of babies each year – seem to play little part in HIV awareness and prevention or in the prevention of mother-to-child transmission of the virus.

It had been on my mind since I met an experienced traditional birth attendant (TBA) who told me she last attended a workshop on HIV counselling in 1992. Hasifa Nalwoga Ssenkayo is 52 years old and with two years of schooling behind her has been working as a birth attendant since 1976.

A mother of ten, Hasifa’s workplace has 14 make-shift beds. She operates in a crude environment where everything is improvised. She knows something about HIV and advises women to go for HIV tests after she delivers their babies. But from her answers to some of my questions it was clear she was confused about how the virus could be diagnosed and would benefit from more training.

In fact Hasifa had asked for just that. She told me she had been to the nearest general hospital looking for collaboration with the medical team to improve her services “but failed to get through”.

South Africa: the HIV waiting game

In South Africa HIV patients continue to feel the effects of a chronic shortage of health workers. Zinhle Mapumulo looks at a problem that refuses to go away.

The Tshepang Clinic in Pretoria is fully booked. The 26 people who enrolled here in November for HIV treatment will have to wait until March for the first of three counselling sessions. Completing these sessions is mandatory for anyone who wants antiretroviral drugs.

The clinic’s manager William Matereke has a huge patient backlog, few staff and plenty of stress. “Over a thousand people are on a waiting list at this clinic currently,” he says. “The list changes every day - some people die while others enrol. It is hard to say how many have died because our data collection system is not up-to-date.”

One doctor and two nurses work at the clinic, based at the Dr George Mukhari Hospital. William Matereke has sympathy for the patients on the waiting list but there is nothing he can do. “At times we utilise volunteers in conducting counselling sessions. But we cannot rely on them – we need permanent staff on board if we intend to run a proper ART clinic," he says.

To qualify for antiretroviral (ARV) treatment in South Africa your CD4 count, which measures the white blood cells that control immunity, must be less than 200. Even if you are critically sick and your CD4 count has dropped drastically you still have to follow the procedure of registering for treatment and attending three ARV adherence counselling sessions.

After the sessions the doctor reviews your cell count and viral load. If the CD4 count is still below 200 and you meet all the necessary requirements you can begin treatment.

Zibuyile Mahlangu [not her real name] lives in Soshanguve and is waiting to start treatment at the clinic. The frail 27-year-old is scheduled to come back in March next year for her second counselling session.