My final day

This is a day that has been full of education for me. The message that came across most strongly for me is that there is resources within ourselves to improve on the food security and nutrition needs within our society. We can also improve on the social support and care of our constituents who are living with or are affected by HIV/AIDS.

The brief speech made by Dr. Lydia Mungherera of Uganda summed this up in not too many words. She spoke of her own experience and how she had been sent home to die. Her mother took it upon herself to find books on nutrition and in in her words "Put her cooking pots together and began preparing healthy meals for her". This reminds us that in most parts of Africa healthy foods grow around us but as Princess Kasure of Zambia put it "Ordinary people do not know what a good nutrition is". Is this a wake up call for all of us on the ground? YES. Let us educate our constituents on what is nutrionally good for them that is locally available and stop waiting for international aid and supplements.

Dr. Mungherera said she is well today because of her mothers cooking, the palliative care she received and the social support of her loved ones. This is something our own home based care providers can help provide given proper guidance and training.

I feel a great call for all of us on the ground to put in greater efforts in holding our governments accountable on delivery of services because the Joint UN Action Team works with our governments. The question is how many of our governments are as aware of the situation on the ground as we in the Civil society are? Are they aware that there is a gap in decisions reached in meetings such as this one and delivery of the promises made? As Princess Kasure aptly put it "People living with HIV/AIDS cannot continue to live on promises".

I go back home tomorrow determined to make a difference through advocacy and education. I want my sisters and brothers to know that we can find good nutrition locally and that palliative care and social support plays a great part in bringing healing and improved quality of life to all living with HIV. Empowering my constituents to know that they can help themselves instead of helplessly waiting for aid will bring a light at the end of the tunnel. I go home to take a message of hope and strength and help fight for proper delivery of services and government accountability. This is so these meetings will not just be meetings but will make a difference in the lives of our constituents through us who get the wonderful opportunity to attend them.

Shukria's last day

The day was really productive with discussions concerning food security, nutrition and HIV & AIDS. All the participants agreed that ensuring food security at family and community levels were important. Women and girls particularly, who are mostly infected and affected by HIV are more stigmatized by HIV and are not considered significant individuals especially in developing countries where no preference is given to their essential nutrition needs.

Less funding is available to meet the nutritional requirements of People living with HIV and their families throughout the world. Global Fund provides this support to the governments of different countries.

An inspiring case study of an HIV+ person from Africa was also discussed whose CD 4 count was only 1. Proper and good nutrition in addition to ARVs helped her to survive. Her mother also played a very critical role in motivating her and providing her with the timely nutritional intake.

It is always pleasant to see donor commitments at big forums, however when it comes to implementation countries are met with many challenges due to the lack of funds and political leaders not fulfilling those commitments for the HIV+ community. It was pointed out that favoritism and personal relationships are preferred in comparison to selection on merit especially in developing countries with regards to resource distribution. These are the issues which really need to be addressed appropriately.

Discussions were carried out on strengthening the agricultural sector since it is very important to market the sector as sustainable and can be strengthened to contribute to timely and proper nutritional items for people living with HIV and their families.

There is a lot of stigma and discrimination against people living with HIV therefore joint efforts from civil society organizations, governments and communities are required to rise above this. UNAIDS and Governments primary focus should be on policies for HIV+ people and a strategy for the implementation of the commitments for Universal Access to Treatment, Prevention, Care and Support. Furthermore, there is a great need for evidence based research on the impact of nutrition for people living with HIV in order to meet their appropriate nutritional needs and to ensure that food and nutrition elements are fully integrated into HIV programming and to ensure quality services delivery.

Fight the victim?

Today (December 8) the meeting focused on critical themes; food security, nutrition and HIV & AIDS. I have always appreciated how these important aspects are interlinked, and not understood why it has taken the world so long to ‘recognise’ it. Maybe they always have, and I know they did in fact, but the practices and interventions at the local level have been divorced from this fact.

A few years ago, HIV & AIDS programmers were convinced that young women in Africa engage in transactional sex in exchange for the three Cs; Cash, Cell phone and Chocolates, period! I have always thought this was a naïve argument to justify risk taking by young female adults in Southern Africa. I was in high school then, and when I went to college, I realized that indeed, transactional sex was rampant; young women would get into relationships with men much older than them. But it wasn’t for chocolates that they did, but for the most basic of things. Some needed money to sustain them through college i.e. college fees, transport, accommodation, food, sanitary wear etc. Due to the economic situation, parents would not cope with the demands from institutions of learning, but the young women were determined to complete their education because they believed that their achievements would help them rescue their own parents and siblings from the cycle of poverty. This remains a fact today.

So today, at the UNAIDS conference, experts took turns to explain how food security and nutrition support are an integral part of the response to HIV. I believe that the world already knows the answers, and all the preconditions for effective HIV responses. Adequate nutrition is certainly essential to maintain a person’s immune system, to sustain healthy levels of physical activity, and for quality of life.

The question is how ready are member states to address the root causes of vulnerabilities, i.e. among women and girls for example. I would give the example of sex workers. Just like school girls and students in tertiary institutions, sex workers are portrayed as greedy, reckless, lazy-money centered-whores who would put their lives at risk for the love of dollars. Just like that. So my government for example would from time to time ensure that there is an ‘operation Chipo chiroorwa’ which translates to ‘operation Chipo it’s time to leave the streets and get married’, that is targeted at ridding the streets of all the sex workers. Sex workers have been targeted as vectors of the disease (AIDS). The latest reports reveal that there is about 90% HIV prevalence amongst sex workers in Zimbabwe. And so it may seem right for government to launch this clampdown on sex workers. So yes, it’s not surprising when the Zimbabwe Republic Police tell you that in harassing the sex workers, they are simply doing their bit in ‘the fight against HIV’ more like ‘fumigation vector control’ in malaria programmes.

So the war has been wedged against women, mothers, sisters, and daughters who, as I have come to understand after a few months interacting with some sex workers on the streets of Harare, are trying to make ends meet. These women are human beings in the first place. They are women who are just trying to bring food to their tables, for their own children, siblings, parents, and for themselves. Zimbabwe has dollarized the economy, but still boasts an over 90% unemployment rate. Where does the food come from for those who do not have access to land because they are daughters, and women ‘traditionally’ who cannot inherit land? Where does the money to pay the rentals and other utility bills come from when no one in the household is gainfully employed? The women that try to sell tomatoes by the road side are harassed by the municipal police. The girls that walk the streets trying to sell eggs and vegetables risk being raped…still risking being exposed to HIV. And it’s sickening to try to compare the sentence that the men who stole a cow, with that of a child molester.
My point is, food security is an important determinant of health, both physical and mental; and where one’s system is compromised due to HIV infection, maintaining a good nutrition becomes even more important in reducing susceptibility to opportunistic infections. Women go on the streets to sell because they want food. With high unemployment rates, poor salaries, droughts, many families find themselves facing starvation. Sometimes they are doing it to raise school fees so that they educate their own, so that eventually, maybe, they can also escape the vicious cycle of poverty.

Our governments and all stakeholders should therefore stop fighting the women who are trying to feed their families, and ensure they address the root causes that lead women and girls to engage in risky behaviours.

• Fight unemployment, not the poor helpless women.
• Fight the poverty and stop harassing the women who are only victims of the state’s failure to deliver for its people.

A sister said at this meeting, where member states, civil society and the UN family alike, are well represented,

‘True leaders will not be remembered for the promises they made, but those they met’.

Show us the money

The amount of resources dedicated towards an agenda is inversely proportional to the priority which it is given, hence demonstrating commitment towards meeting set milestones. Today, just like yesterday, the following was reiterated during the UNAIDS board meeting: We are working towards: Zero new infections. Zero HIV related deaths. Zero stigma and discrimination. I believe these goals are achievable, and there is need for concerted effort by all stakeholders in achieving universal access to treatment and prevention for example.

I sat through the meeting wondering if all commitments being made would be met and how? Or is this going to turn out to be just yet another set of broken promises? HIV is a reality, and continues to wreck homes, villages, nations, and communities. Resources for HIV & AIDS seem to be dwindling, but we continue to make more promises. It seems the donors are using the global recession to justify cutbacks in HIV & AIDS funding, and backtracking on promises made.

I worry. I worry about how people are comfortable flashing slides that demonstrate how Africa, specifically, Southern Africa – (and mostly young women in Southern Africa), bear the most HIV/AIDS burden. But when it comes to committing resources, there is much reluctance. I see no graphs, there are no slides.

Why is it that only a small fraction of countries in Southern Africa {the hardest hit by HIV} will qualify for the Global Fund for HIV, TB & Malaria Round 10? Where will the money to support the rest of the countries come from? I think there are too many slides flashing around that people have ceased to realize that statistics don’t die… that it is actually human beings that die; our sisters, mothers, fathers, children, workers, leaders, etc. And even when they die, the suffering continues. So for example… an old woman whose five children succumb to AIDS and die, because they were not able to access ARVs, is stigmatized for having raised children of loose morals.

So in other words, stigma is with us until we reach universal access to treatment and prevention. And stigma breeds stress; one of the biggest killers. In case you didn’t know; it is stressful for an HIV positive person to watch hopelessly, somebody in the same situation as them waste away and die. I believe there is much strength and hope, and faith, and positivity {and many other good effects} in looking around and finding that an HIV positive person who lives in the same village as yourself {not someone on TV, in a book, or being paraded during a World AIDS Day launch- and made to give ‘testimonies’, and the Guest speaker once to be in as many pictures with them etc}, but someone you grew up with, and stays two houses away from you can actually lead normal lives, because they have timely access to comprehensive health services, food, and psychosocial support.

The UNAIDS strategy and operational framework holds the hope for hundreds of people in my village, those infected or affected with HIV. The expenditure cutting mechanisms {on staffing, travel costs, and other service costs} that UN agencies have committed to putting in place are good steps in the right direction, and all stakeholders should plan to cut down on service costs.

It is only when there is an indication and strides made towards financing these plans of Action that I can start dreaming about that day. That day when a Ministry of Health and Child Welfare vehicle shall arrive in my village; I can imagine the dance, ululation, song, drums, dance, as the children and women {and the few men recruited through ‘male-involvement-efforts’} hail and celebrate the arrival of the very first consignment of ARVs at the local clinic. And hopefully boxes and boxes of a speed test CD4 count instruments, one similar to the glycometre that the UNAIDS Executive Director, Mr. Sidibe showed the board yesterday. The Doctor {who is a woman} and the Sister-in-charge {a man}, are here, not for the hand over take over ceremony, but will be resident at our clinic for months, to run a training/orientation/ support course on how to run this one-stop-shop with the local nurses and nurse AIDS; on management and treatment of opportunistic infections, to enrolling people for treatment. And when the men realize it’s serious, they too shall join the dance in celebration.

The question is when shall this happen? Where is the money? I urge the UNAIDS Board not to postpone the TRIPS agenda, because the developing world needs the drugs. Women, girls, men, children, families, are counting on this gathering to keep the dream alive, and ensure that we do not postpone the TRIPS agenda, because manufacturing generic drugs is important in the journey towards achieving Universal Access.

In the mean time, {and most importantly}, our governments should continue to recognise the importance of creating environments, in-country, that does not exacerbate people’s vulnerabilities. For instance, it is critical to build a culture of respect and tolerance, and protection of all citizens regardless their gender, race, ethnicity, sexuality or any other status. The entry point is Law reform (and recognizing of course that laws are not self implementing).

I hope to continue to see improvements {by our own governments} in ensuring that women, girls, sex workers, and other vulnerable groups’ rights are protected from sexual violence and other forms of violence, so that we can maintain unfettered access to our full sexual and reproductive health and rights, in the context of HIV. This is an integral part of the commitment to combating HIV and AIDS among women.
I am also anxious to see how our governments will implement country plans, {beyond launching}, who will be involved in steering the processes and at what levels. Whilst donor support is still important, how do governments intend to scale up efforts to harness locally available resources in order to finance health, and to utilize these efficiently?

African governments can further demonstrate commitment by ensuring the development of expenditure tracking mechanisms, and ensuring that women’s groups are involved in tracking progress in this fight.

Indeed, Africa needs the money. For the sake of the women, the girls, the children, and all the other vulnerable groups, the world should not give up on us. Not just yet! In the mean time, I firmly believe, that the world has got enough resources to feed and heal us all, but not our greed and indulgence. Therefore all stakeholders have a duty to commit to utilize available resources efficiently and effectively, in delivering results.

UNAIDS Evaluation and Gender on the Agenda

Today the discussion started with the Second Independent Evaluation of UNAIDS, as we ran out of time in the meeting yesterday. Although there is a new Division of Labour (DOL) amongst the UN agencies in relation to who will be the lead agent or convener on the implementation of the UNAIDS priority areas, it is still unclear how this new DOL will work better. It was stressed in the discussions on the floor that all stakeholders must be involved in the implementation, decision making and monitoring of the activities. I appreciate the ambitious UNAIDS strategy, one of the recommendations implemented from the Second Independent Evaluation, though I am interested to see how this will affect us on the ground. The mention of key populations and human rights in the UNAIDS Strategy will really affect my work as my organisation works directly with these population groups in care, support, advocacy and prevention.

I was interested to hear about the work UNAIDS will be doing to assess needs and build the capacity of their staff including training of the UCC’S and the RSTs on areas of human rights and gender equality. The UNAIDS made a commitment to move towards a single administrative of the secretariat and encourages on- going effort of the secretariat to use the administrative cost by seeking the most effective cost provision of the service. With the leadership of a core working group, which consists of civil society, UNAIDS, government, People living with HIV an assessment for capacity building will be done in a number of countries.

The next agenda item was a discussion on Gender Sensitivity of the AIDS response and interventions from the floor requested a stronger linkage between women and girls sexual and reproductive health and HIV. Interventions from the NGO delegation stressed the importance for doing research on the female condoms. NGO’s requested UNAIDS to ensure indicator and budgetary allocating in relation to outcome areas of the meeting. The needs of women and girls on the country level need to be met especially those needs that are in line with the UNAIDS Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV (the Agenda). Meaningful partnerships such as UNAIDS, national stakeholders and civil society was also highlighted. In terms of reporting, best practice models on the collaboration between UNAIDS and civil society to be documented in order to better understand and address HIV specific needs of women and girls, including the promotion and protection of their rights. As part of the NGO interventions, a progress report on the achievement of the implementation of the Agenda was requested to be presented at the 28th PCB meeting. This comprehensive report is to highlight specific outcomes for each country, which should demonstrate action and inform the work of the UNAIDS joint programme at country level. There was also an ask for a budget with core and supplemental costs dedicated to empowerment of woman and girls in the context of HIV.

An Overview of Impressions

Today woke up in good time as I had a good night and feel well rested. The first part of the meeting this morning was a report from the Task Force on the Second Independent evaluation. It felt for me like it dragged on for a very long time because I was eager for us to get on with the days agenda which was pretty long. The first discussion was on Gender Sensitivity of the AIDS response which was a combination of a report back on the implementation of the UNAIDS Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV (the Agenda) and linking sexual and reproductive health and HIV interventions (follow up to a thematic segment from the 26th PCB).

I was very impressed by the presentations from Rwanda and Liberia on their implementation of the roll out of the Agenda. It is evident that most of our continent bears the burden of women being discriminated upon by cultural practices, violence and gender inequality issues amongst others. I am not at all saying that this is limited to our continent but it is a call for a stronger stance from all of us women to say no to practices that put us, our children, families and in extension the entire community at higher risk of infection. The input by one of the Member State Delegations also struck a chord in my heart because it is one of the leading topics in most of the advocacy in my country. This is the fact that most women in long term relationships like marriage are at a higher level of vulnerability. It has been seen in my country that a lot of new infections are occurring in marriages or long term relationships. Of even greater importance is the fact that the main barrier to women accessing HIV services is linked to stigma and gender inequality issues.

After this was the issue of AIDS, security and humanitarian response. The input that most struck me here was the issue of violence against women in conflict and how this plays a key role in putting women at risk. Cross border issues that more often than not are ignored were also discussed. Once again this is close to my heart because it happens a lot in our continent and follow up on treatment is interfered with or stopped further jeopardizing an already volatile situation because most countries concentrate on national provisions only.

I am beginning to feel overwhelmed by the weight of the various issues at hand when we get to the Universal Access issue. Ideally this target was to have been reached by the end of this year. However by all standards it is understandable that it is not an easy achievement to reach despite the tireless efforts being put in by all the stakeholders.

The meeting got interesting when the High level June 2011 meeting began being discussed. The modalities of the meeting were given by the Ambassadors of Botswana and Australia, the co-chairs of the High Level Meeting. They called for participation at the highest level, meaning that governments should send members of parliament or preferably Heads of State alongside youth, women, orphans and PLHIV.

Finally the election of new delegates went ahead as planned and was uneventful. We were invited for snacks and to the NGO Delegation's debrief of the days events. Everyone was in agreement that the PCB Chair had been very effective in getting the days agenda run smoothly and efficiently.

I feel like I am beginning to understand this whole meeting better. Its a wonderful opportunity and it makes me wish that all people involved in HIV work or directly affected by it could be here to see how much effort is being put in by all the stakeholders to get things moving in the right direction and in good time too. It fills me with hope for the future of all those affected by HIV.

Blogging for Rights at the UNAIDS Board Meeting

I learnt at an early age that Christianity and tradition were like fire and water, incompatible. So on Sundays the preachers and deacons at church would emphasize how those who were still clinging onto their traditional gab, spears, stones, ceremonies, names etc, ought to change them. For example, I grew up knowing that everything about traditional and culture practices (maybe except for lobola- the buying and selling of women’s bodies I feel it is in it’s current state- and can be improved as a practice, as long as the men are willing to share power/ or women are willing to fight for power- anyway this is debate for another time- ) were bad, and that my father for example, would burn in hell- the bottomless pit, because he occasionally gave people with snake bites, scorpion bites, tummy aches, head aches…some concoction made from herbs he dug up in the forest. He was a traditional healer. When I became older however, and HIV had been discovered, I started hearing a lot of talk about herbal treatment for positive living. Herbal gardens sprouted all over the village, and donors were pouring money towards that. Home based care groups were formed in church, groups that would be responsible for the herbal gardens, and demanded that only baptized church members would be allowed to join.

This is when I started to see some harmonization (progressive) between the church and tradition, {in the face of HIV and AIDS}.
I know I said earlier that the church and traditional were old enemies, and now, in the advent of HIV, we would witness a merging of ideas as a way of serving the ‘people’. But there is something that I have come to learn. That although these two institutions have for so long seemed to be almost incompatible, for the longest time, they have been fighting each other during the day, and sleeping together at night.

‘Culture’ and religion have both been used to keep women in subordinate positions, and to intimidate those that dare think outside the box, to instill fear and to silence the world into submission
I witnessed that this afternoon at the UNAIDS meeting. Religious fundamentalists basically do not agree on many things, but their ideas tend to converge in supporting patriarchal tendencies that promote hierarchical sexual relationships, sexual domination over, and in denying women control over their bodies and sexuality.

So, today, the UNAIDS strategy for the next five years almost came to a standstill because people want to moralise the debate on HIV and AIDS. So they will disregard the facts. That young people, sex workers and women in general for example are getting infected at alarming rates does not count for some leaders, because they feel they have a ‘moral’ responsibility to police and control people’s bodies, lives, and sexualities….everything. There is certainly a lot of surveillance that goes on, and one wonders where this strategy will get us, if member states who are signatory to a lot of agreements based on human rights principles (which are inalienable, indivisible, interdependent….), still can not endorse an evidence based paper like the strategy before us this afternoon. I am too scared what else can we expect on the ground.

I believe that the world does not necessarily have a deficit for policies and strategies to respond to the AIDS epidemic. What lacks is the political will from some governments; for leadership to set aside their self serving agendas, and choose to respect the rights of the human person, and take responsibility towards implementing evidence based interventions and not let religious and cultural fundamentalisms erode all gains made in the fight against the pandemic.

The key word here is political will. It’s one thing investing in HIV and AIDS interventions by way of providing financing for programming, and yet another to ensure that interventions developed at the local level is responsive to the situation on the ground. For example, I always ask myself why billions would be invested towards male circumcision and targeting 30 and 40 year old men (in my country at least), instead of responding to the issue of Violence against women, which tops the list in fueling the epidemic. Or even directing the scarce resources towards procuring ARVs so that that thousands of people needing ARVs treatment can access the life saving drugs.

It has been universally acknowledged that HIV/AIDS have a woman’s face, but it is disappointing that religious and traditional fundamentalisms that are rooted in patriarchy have come in the way and impede progress towards winning the fight against HIV & AIDS, because violence against women continues to spread like a veld fire, but governments continue in a business as usual mode. Law enforcement is poor, because agencies will cite culture and tradition, that domestic matters should only be solved amicably, citing customary law, which to me is just a set of beliefs and values which benefit men and disadvantage women and which are safeguarded to ensure the sexual slavery of women.

In the name of culture and religion, young girls are married off, and have to endure violent relationships {and it is no secret that where violence is, so is AIDS}. It is the poor, the marginalized groups like women, and sexual minorities who bear the brunt of patriarchal tendencies that promote hierarchical sexual relationships, sexual domination, and deny women control over their bodies and sexuality.

The time is now to ensure that governments who receive support can commit to addressing the critical issues increasing vulnerabilities. The time is now for the women of the world to just say no, enough is enough, and refuse to be represented by people that put their self serving ideas forward, ahead of the people’s real needs.

We refuse any more patronage. We demand that our voices be heard. We demand representation in these boards. It is the women and marginalized populations who are getting infected, and dying, and it is only they that can treat these matters with the urgency they deserve. Want value for money? Do not entrust our resources to elements that are perpetrators of violence, the same agents that fuel this epidemic…femicide…who will support the killing of women in the name of culture of religion. Value for money will be realized if affected groups are at the decision making table, in the field implementing and monitoring progress….every step of the way.