Thursday, November 29, 2007

The fight against HIV: there are no short-cuts

Opinion pieces
28 November 2007
By Dr Mukesh Kapila, Special Representative of the Secretary General for HIV, International Federation
In the neighbourhood of Mabopane, a suburb of the South African capital Pretoria, she is known as “Auntie Elizabeth”. This 37-year-old woman single-handedly looks after the five children left behind by her sister – who died of AIDS in 2003. One of the children is living with HIV.

Elizabeth is alone in having to care for the five children who would otherwise have been left to fend for themselves. The family is crammed into a garage, for lack of anywhere better to live. However the most painful difficulty is that family lives in isolation, scorned by the neighbours who stop the youngsters from playing with their own children. They feel it’s “too risky”.

Auntie Elizabeth’s situation is by no means unusual – and that’s just the problem. There are thousands of children living without an adult, deprived of all family contact when the extended family is wiped out by AIDS. The older children are often forced to interrupt their studies in order to look after the younger ones. Girls are particularly vulnerable. They are easy prey for those who try to buy their virginity in order to cure themselves of AIDS – or so they mistakenly think. This is what certain charlatans posing as healers have tragically promised them – for a fee.

This is the reality of HIV. Southern Africa, where more than 12 million people are living with HIV - of whom 860,000 are children under the age of 14 - has been hit particularly hard by the pandemic. The number of children orphaned by AIDS in this region alone is expected to double by 2010.

While southern Africa is the hardest hit region, the rest of the African continent is also seriously affected. Very often there are associated serious breaches of basic human rights. This includes violence against women: not only the rape of women and girls in situations of armed conflict but also sexual and gender based violence that is highly prevalent in most domestic and community settings.

But Africa does not have a monopoly on suffering when it comes to HIV. The vulnerability of women and girls can be just as striking in other regions, a reflection of socio-cultural factors as well as the pervasive inequality of the sexes. This is so, even in well-off parts of the world such as in Latin America and the Caribbean where, over past decades, women have become much better educated and economically active, but gender inequalities persist, and the HIV epidemic has an increasingly feminine face.

The same is true for Asia and Europe – particularly eastern Europe. Ignorance remains one of the driving forces behind infection. Many young people in the former Soviet republics do not perceive HIV as an issue that concerns them. Meanwhile, each day women are giving birth to children who are HIV-positive.

In recent years, progress has been made in making a wider range of anti-retroviral treatments available to those living with HIV. This trend is encouraging but reliable access to treatment is still something of a lottery. Civil society efforts must be combined with those of organizations of people living with HIV to demand that governments provide greater – and more consistent - availability. However, treatment is not the quick fix to the epidemic. Primary prevention needs to be re-energised and the key to this is the greater inclusion of currently stigmatised and marginalised sections of the community.

We must scale-up action on all fronts. Hence, one year ago, we launched the Red Cross Red Crescent Global Alliance on HIV, which aims to double our HIV programming by the end of 2010. Some 50 of our 185 member National Societies have already actively joined–up to “do more and to do better” in HIV prevention, treatment. care, and support, and in addressing stigma and discrimination. They are doing this by expanding outreach through our network of members and volunteers in communities, who are thus taking on practical responsibility and leadership.

A specific example is the Filles Libres’ project of the Cameroon Red Cross Society. This targets one of the most vulnerable and stigmatized groups: women who sell sex. Red Cross volunteers make contact with these women – who often take up prostitution as survival livelihood – to encourage them to get themselves tested voluntarily and to protect themselves. They also work with the clients of the sex workers to do the same. This campaign is possible only because our volunteers include a number of women who come from the same background as the sex workers, speak the same language, understand the problems they face, and get to trust each other. This is essential to break the vicious cycle of infection: unprotected paid sex, infection of the spouse when the ‘client’ returns home, and the transmission of the virus from mother to child.

This example illustrates the daily challenges of HIV work: tackling prejudice and stigma, re-enforcing prevention messages, helping people living and dying with HIV, and not forgetting the factors that underlie personal and societal vulnerability. The point is that there is no substitute for communities having to take charge of their own destinies and shaping their future – for the better. This is a long-term task requiring permanent commitment. There are no short-cuts.