HIV/AIDS

[brianold]

forum dedicated to discussing the HIV/AIDS epidemic.

this first article reminds me that gender roles and discrimination play a large role in the spread of the disease... why don't our continent's laws hold men more accountable?

other points made deal with us not becoming totally dependent on drugs (that are not cures) as the final solution, and a need for organizations to work together so they are not overlapping... also points out the rush to be an HIV/AIDS based organization because that's where the money is at especially in Africa where so much of the charity money from the western nations are funneled to.

bk


-----
BREAKING THE HIV/AIDS SPELL IN AFRICA
http://www.pambazuka.org
Salma Maoulidi

Last Friday evening, the United Nations adopted a Political
Declaration of Commitment on HIV/Aids following a meeting in New York
to thrash out a response to the pandemic. While welcomed in some
quarters, the declaration has also faced criticism from an African
civil society grouping, who described it as an “utter disappointment”
and declared a Week of Action - from June 13 to 17 - to mobilize
support for previous commitments made by African governments to
fighting the pandemic (Please see the HIV/Aids section of Pambazuka
News for more details). In the article below, Salma Maoulidi goes
beyond showcasing the pandemic in an attempt to “deal with why it is
and is allowed to be”.


Tanzania has a national HIV/Aids policy and is in the process of
finalizing legislation on HIV/Aids. The expectation is that once the
policy and legal framework is set, people living with HIV/Aids and
their families will be afforded greater protection. But will a legal
framework that solely addresses the public health dimensions of HIV/
Aids and not the intimate aspects of personal relationships that
maintain the status-quo in power relations between the sexes suffice?

Treating an invisible syndrome

When one reads the alarming statistics explaining the magnitude of
HIV/Aids in sub-Saharan Africa one gets an impression that people are
dropping down like flies. One would think that as one walks the
streets, every other person would be noticeably HIV positive. This,
however, is not the case, not because HIV/Aids is not present but
because it is rendered invisible - something that makes ongoing
efforts to combat HIV/AIDS ineffective, if not difficult.

While HIV/Aids is very much in our midst it remains hidden from many
either by choice or by design. It remains hidden by choice because we
choose not to see it; or those that are affected by it choose not to
divulge their status. It remains hidden by design when those who have
it go to extra lengths to conceal their positive status. Also, it
remains obscured when the state fails to address the problem at its
core, that is confronting the underlying cause contributing to
widespread infections rather than its consequence.

I have been following the progression of HIV/Aids since the mid-
eighties when the formulation of the first national response against
HIV/Aids emerged, but it remained invisible to me until the late
nineties. Until then my association with HIV/Aids was based on health
statistics and my long association with women’s sexual and
reproductive health and rights. Putting a face to someone living with
the virus came much later. But when these live testimonies finally
emerged they were persistent in underscoring the pervasiveness of the
pandemic. From the outset, it became clear to me that each story of a
women who had contracted the virus was peculiar and in most cases did
not meet the popular myths around HIV/Aids.

There are many dimensions to the problem that is HIV/Aids, something
that is not so clear with prevailing responses against the disease.
One can only appreciate the complexity involved in combating the
pandemic when one reviews the stories of countless women, men and
children infected and affected by HIV/Aids. It is also these stories
that inform my political stance on the adequacy of existing HIV/Aids
approaches in combating the pandemic.

Protecting the unsuspecting

One of the first cases I came across involved a bright girl, full of
life and humour. I met her for the first time when she was ten but
looked more like a five year old. She was born HIV positive, a fact
that led her father to abandon the family. It was left to her mother
and elder sibling to love and provide for her amidst great hardship.
Although an innocent child, she was not spared the humiliation meted
out on PLWHA’s that resulted from prevalent institutional ignorance
about HIV/Aids. Her teachers openly discriminated against her,
forcing her to wear a red badge to signify her HIV status.

Fortunately, her mother joined an association of PLWHA which provided
her and the family with much needed moral and material support. Her
sisters, who were not positive, became peer educators and volunteers
for an HIV/Aids community based programme. She thus never saw herself
as a victim. She accepted her condition and sought to live to the
fullest in spite of the fact that she was positive. Her status was
only an issue when it made her too sick to play or attend school. She
died before her twelfth birthday, unable to realize her many dreams.
Her brave attitude gave us a useful advocacy platform to intensify
the campaign for the rights of PLWHA.

Progressively, the reality of HIV/Aids came close to home when a
close friend of mine lost her baby girl. Although she had suffered
bouts of TB it only became clear that she may be infected with the
virus after her very sick daughter was diagnosed with the virus.
Indeed it is not exceptional that many women get to know about their
positive status in this manner since they do not fit the profile of
women who are likely to be infected with the virus in the sense that
they are not prostitutes or “loose” women but women who are in stable
relationships, the majority having the respectable status of being
someone’s wife and, therefore, by local social standards, outside the
ambit of the risk category associated with immoral behavior.

Consequently, a significant number of HIV positive women I know
contracted the virus as unsuspecting victims. They were brought up to
believe that it was enough that they were in a happy, healthy and
lasting marriage. The husband’s fidelity was immaterial to complete
this equation. On the contrary, the overwhelming perception is that a
chaste and faithful wife sufficed to protect the family from ill
health and ensure a strong progeny. Increasingly women are finding
that an institution that was traditionally meant to provide them with
security, stability, health and respect is in fact endangering their
lives and livelihoods.

Many of these women are torn between confronting their problem and in
so doing drawing attention to themselves, a fact that leaves them
vulnerable to public scorn and stigmatization. Importantly, it has
the potential to ostracize them from traditional systems of support,
especially after their spouse rejects them upon divulging their
status. Indeed it is the dilemmas and contradictions women face as
the weaker sex that puts them at risk of contracting the virus.
Certainly, it is the denial of women’s agency in matters of sexual
and reproductive nature that informs women’s social and economic
predicament, a situation intensified by the HIV/Aids pandemic.

Are we fighting a disease or a curse?

The contradictory nature of the disease vis a vis women’s wellbeing
is most evident in the story of my namesake, now deceased, who I came
to know by virtue of my work with Muslim women. She was an only
child, begotten late in life. Her elderly mother was anxious about
her welfare after she passed on, such that when a widower proposed
marriage she hastily agreed, believing that she was marrying her
child to a responsible man. She did not know how her future son-in-
law lost his wife nor did he oblige the information. It seems that he
had two main concerns - either to draw upon the youth and vitality of
his young bride to will himself to good health or to have a healthy
person to care for him as his health deteriorated. In either case it
was not the welfare of his new wife that was paramount to the fatal
union nor did he take any measures to minimize the risk of infection
to his young wife.

Next my cousin fell ill to recurrent bouts of TB. In his quest to
prove that he did not have something more serious, he repeatedly
neglected to complete the prescribed dose for treating the disease,
creating resistance against TB. His mother and siblings never
accepted that he may have contracted HIV, though they knew he was a
womanizer. Instead they were more willing to forgive his philandering
but content to blame his wife and her mother for bewitching him. In
vain my aunt tried to break the marriage as her son’s condition
deteriorated, perhaps to minimize the likelihood of her laying any
claims to the matrimonial property, but failed. To our dismay my aunt
unceremoniously chased the widow out of the house immediately upon
completing her iddat (the mourning period) in spite of the fact that
she had two young sons.

Then the young woman who helps us around the house was afflicted by a
double HIV/Aids tragedy: her brother in law died after a long illness
that was explained as diabetes coupled with witchcraft. During her
time off she visited her sister and took care of him. There is no
knowing what risk she exposed herself to as she only confirmed that
he may have died of Aids after her sister succumbed and died soon
after. This tragedy ended the working life of this young woman as her
mother went into shock, forcing her to take a leave of absence to
nurse her until she died. To save her from a predicament like her
sister’s, her uncle and brothers planned to marry her off to a man
who had been divorced thrice.

While a number of these women were ignorant about their status, a
number were in denial not because of arrogance but because they
feared the repercussions their status might have. My friend took some
time to accept her HIV positive status. A lot of anger was exhibited
against her husband’s long love interest and while she came from a
religious family she readily invoked witchcraft to explain her errant
husband’s behaviour. Perhaps it was more tolerable to accept that her
husband was not acting in selfish disregard of her feelings and
health were it not for an evil third hand or influence.

My most recent house help must have known for sometime she had the
virus but instead of focusing on her condition actively sought out
other women suspected to be infected as if in an attempt to deflect
attention from her own status. Otherwise she hid her ill health well,
substituting it with other debilitating diseases like malaria or
typhoid. But when her ten-year old daughter died, she lost her will
to live and succumbed almost two months later. The fate of her
husband is unknown since he is adamant his daughter was a victim of
someone’s bad spell, a view his wife never sought to correct lest she
became suspect and was thrown out in the streets.

Interrogating the source of repeated transmissions

The stories serve to underscore certain truths that hardly feature as
the key issues in the battle against HIV/Aids. It is more likely for
women to admit their HIV status than it is for men. In most cases I
have come across, the women were categorical that it was the sexual
permissiveness of their partner that put them at risk. In many cases
they were unsuspecting victims. In some cases, they suspected
infidelity but were helpless to stop it since as opposed to their
sexuality being regulated, their husband’s infidelity was given free
reign by religious dicta and the legal framework. While society is
more preoccupied with the status of the woman during marriage -
whether she is a virgin or not; whether she is rebellious or not;
whether she is respectable or not - equal consideration is not given
to the status of her partner. On the contrary legal and social
institutions tend to extol men’s sexual prowess and irresponsibility.

Likewise, while it is common for women who contract the virus to be
punished for their condition there is never talk of compensating them
for the harm inflicted on them and the ensuring violation of their
privacy and property rights. My namesake was disposed of all her
property by her in-laws - even her cooking pots - though it was well
known that her culinary skills sustained the family during their
short married life. She attempted to fight for her rights but died
without justice being realized. The sister of my house help was
evicted from the house where she lived and nursed her husband and
ended up living with a relative before being bundled back to her
village to die.

After initial denial my friend is living an open life. She recently
lost her husband and is in the middle of a property distribution
exercise directed by his family. While the family is keen to expedite
her share of inheritance, perhaps in view of her condition, there is
no mention of compensating her for the harm her late husband caused
her, if not knowingly then by sheer negligence. She dares not bring
up the issue lest her in-laws fall short of being generous towards
her. It is this attitude of looking at women as creatures to be
pitied and helped, instead of full partners in a relationship, that
limits their agency and bargaining power in a relationship. Surely,
awarding her compensation is not a matter of retribution or her
inability to forgive. On the contrary it is her ability to forgive
and go on with her life that contributes to her positive and healthy
living. But should such chivalry be abused?

The wrong these women have been subjected to goes unrecognized. The
contributions they made to families in terms of monetary and non-
monetary forms of contributions go unacknowledged. Instead, these
women are vilified by relatives and society for their positive
status. Their positive status is equal to a death sentence and
licenses their dispossession. Their continued existence means they
are delaying the process of wealth transfer and if the virus won’t
kill them in time, then heart ache and harassment are efficient
mechanisms to expedite the sentence!

The unresolved politics of HIV/Aids

Most governments have failed to look at the social impact of HIV/Aids
beyond the rhetoric of sharing the burden of looking after those
affected by the HIV/Aids scourge. And while the pandemic presents new
opportunities for governments to address gender inequalities there is
paralysis in taking deliberate action to promote natural and social
justice. Certainly the pandemic presents an opportunity to influence
reforms in law and attitudes not only towards HIV/Aids but in
reforming gender relations. Other than reaffirming state
responsibility towards principles of gender equality and justice, it
affords states an opportunity to engage in social engineering towards
meeting constitutional and civic commitments to its citizens, male
and female.

The development sector’s HIV/Aids response fares no better. While it
is commonplace to maintain that having HIV/Aids does not amount to
having a death sentence, prevailing policies, discourses and practice
related to HIV/Aids continuously pass death sentences on those
infected by the virus. Though my organization addresses HIV/Aids in
the context of reproductive health, I resist working in the field
mainly because the overwhelming support to the sector seems to
promote welfarism - approaching infected persons as helpless victims
thereby subscribing to dominant attitudes that tend to seal the nails
on the coffins of those afflicted by the virus. This is an approach
to development that we abandoned two decades ago in favour of a more
empowering development approach and discourse.

Indeed, whereas we have tried to reclaim the dignity of people who
survived gender based physical and sexual violence we are shamelessly
victimizing people infected with HIV/Aids. The biggest pastime for
people who want to placate their sense of guilt or get a piece of the
HIV industry in my country are projects involving HIV/Aids orphans
where countless children who are infected or who lost parents to the
disease are not allowed to get over their loss and the stigma
associated with their loss. The association with HIV/Aids is the
brand that sells. Oblivious are we to the message that underlies such
projects: Why can’t these children get on with their lives and be
assisted by virtue of being orphaned and not because they are
orphaned by HIV/Aids?

Also appalling is the wastage of resource poured in by the
international community on material purchases and workshops that do
very little to actually help communities deal with the HIV pandemic.
Indeed, HIV/Aids has become the new development craze diverting much
needed income from more sustainable development interventions. Why is
overall spending in preventive health and reproductive health falling
when they form part of the equation for an effective heath response
to the pandemic? I visited Rwanda in 2004 and was appalled to find
that each major UN agency and international NGO was into the HIV/Aids
sector with very little coordination between them. I found a similar
situation in Zanzibar where the bulk of advocacy organizations felt
compelled to get into the HIV/Aids sector to secure funding to remain
afloat.

I am equally wary of the ongoing politicization of the question of
access to anti-retrovirals for PLWHA. Certainly I have no desire to
profit pharmaceuticals, who seek to commodify people’s health in the
name of a pseudo-cure. I am also hesitant to create dependency on the
drugs in the absence of better nutrition and a guarantee that the
scientific community is serious in finding a cure or a better drug
regiment. The idea is not to create another dependent population,
this time not only on food aid or donor aid but on ARVs. The
objective should be to empower PLWHA to live healthy and independent
lives without fear of incrimination, stigmatization or
impoverishment. It should be about giving security and dignity to
those infected and affected by HIV/Aids.

Conclusion

Statistics explaining the magnitude of the pandemic are plentiful. It
is however not helpful when numbers are considered in a vacuum. I
took inspiration from a book a young woman participating in our
mentoring program is working on to open dialogue about HIV/Aids. The
book is particularly insightful as other than using narratives of
women infected and affected by HIV/Aids to expose the human dimension
of the pandemic, it does so while charting her personal trajectory
with HIV/Aids. She explores myths about the disease; education and
prevention strategies; and personal and community responses they
invoke. Certainly it is in understanding the interactions that inform
individual HIV/Aids experiences that more sustainable prevention
options will evolve, options that go beyond showcasing the scourge
for what it is but attempt to deal with why it is and is allowed to be.

* Salma Maoulidi is the Executive Director of Sahiba Sisters
Foundation, a development network that works with the concerns of
Muslim and provincial women. Sahiba’s mission is to build the
leadership and organizational skills of women and youth. It has
network members in 13 regions of Tanzania.

[brianold]

The African Common Position On HIV/AIDS

“We, Heads of State and Government and Representatives of States and Governments, assembled at the United Nations, as a matter of urgency, to address the problem of HIV/AIDS in all its aspects and to secure a global commitment to combat it in a comprehensive manner, solemnly declare our commitment to address the HIV/AIDS crisis by taking action as follows...”
~ Preamble, Declaration of Commitment

read the full thing here:
http://www.ungass.org/index.php/en/ungas...commitment