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Africa Update: HIV/AIDS News
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Nov 6th, 2009 - 04:32:36 |
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BOTSWANA: A risky combination of alcohol and sex
SELEBI-PHIKWE, 5 November (IRIN) - On a recent Wednesday evening, Gillian Otsile, a volunteer at a local NGO, Men Sex and AIDS, approached a group of young men drinking cartons of traditional sorghum beer at a tavern in Selebi-Phikwe, a mining town in northeastern Botswana.
In a country where nearly one in four adults is infected with HIV, Otsile's focus is talking to the patrons of local drinking establishments about the risks of combining alcohol with sex.
Most of the group in the bar in Selebi-Phikwe are unemployed and rely on occasional piece-work to buy beers for themselves and any girls they meet. Tato, who is slightly older than the others and works as an electrician, confirmed that after buying a girl beers all night, he expected to go home with her.
Using a condom depended on how drunk he was. "If you're drunk, you lose half the sensation, so the only way you can do it is flesh-to-flesh. You forget about HIV."
Tato's comments echo the findings of several studies: heavy drinking is associated with an increased likelihood of engaging in sexual behaviours that put individuals at risk of HIV infection.
A 2006 study in Botswana found that both male and female heavy drinkers were above three times more likely to have unprotected sex than non-drinkers; their odds of having multiple partners and paying for or selling sex were also much higher.
Need for policies
Alcohol use as a driver of HIV infections is evident throughout southern Africa, the region worst hit by the global HIV/AIDS pandemic, but few governments have implemented policies to address the problem.
However, in 2008 Botswana President Ian Khama's government acknowledged the link by legislating shortened hours for bars and slapping a 30 percent levy on alcohol. It is too soon to say whether these measures have changed drinking habits enough to have an impact on HIV infection rates.
Some commentators say people have simply switched to drinking traditional beer called Chibuku, which still sells for less than US$1 for a one-litre carton that can be shared between friends. One of Tato's friends pointed out that bars are also popular places to buy condoms, so "if the bars are closed, they're not going to find a condom."
The tavern adjacent to the office of District AIDS Coordinator Lamech Myengwa is still doing brisk business, especially at month-end. "In Botswana, drinking has become a pastime," he told IRIN/PlusNews.
Few small towns have a cinema or much else by way of recreational facilities. "Every evening people will go to the bars to socialise - that's where everybody mixes, young and elderly - no wonder there is this intergenerational sex going on."
Government figures from 2008 show that HIV infections in Selebi-Phikwe, as in most of Botswana and across southern Africa, are highest among young women and older men, demographics that tend to be replicated in the bars.
"The women are young girls, from 16 [years old]," said Dikgang Keabetswe, a project leader at Men Sex and AIDS, one of several community-based organizations receiving funding from Population Services International (PSI), a global health organization, to raise awareness about alcohol and HIV in local bars.
"Some [young women] go [to the bars] without a cent; they look for males to buy them something to drink, and even for transport money. Men mostly expect sex in return. The BCL guys [workers at the local copper and nickel mine] - those who have more money - are mostly over 25."
Employment opportunities for women in Selebi-Phikwe have shrunk since several textile factories closed in the late 1990s, and some have turned to commercial sex work, while others occasionally exchange sex for drinks or small amounts of cash.
On her way home from buying a bag of maize, Elizabeth, 27, has stopped at the tavern where Tato and his friends are drinking. "I want a drink but I don't have money, so I'm hoping someone will buy me one," she said, admitting that some men expected sexual favours in return.
"If I want, I go with him. Sometimes I use a condom, but if he says, 'I don't have a condom', and I see he has a lot of money, I'll agree ... In life, we need money."
She recently tested negative for HIV, but believes it is only a matter of time before she contracts the virus. "I think everyone nowadays has HIV," she said.
Tato and his friends have similarly fatalistic attitudes and a reluctance to change risky sexual behaviours; several said they slept with sex workers whenever they had money.
"I'm not afraid of HIV because there are ARVs [antiretrovirals] for free," said one, referring to the government ARV programme which reaches nearly 100 percent of those in need of the medication. "I'm afraid of it ... when I'm sober," laughed Tato.
Changing behaviours no easy task
Persuading people to reduce their alcohol consumption will have little effect on Botswana's HIV infection rates unless it is accompanied by fundamental changes in attitudes and behaviours.
The young volunteers doing the PSI-funded interventions at bars are trained to strike up conversations with people not only about drinking responsibly, but also about the common practice of having multiple concurrent partners (MCPs) - perhaps the biggest and most neglected driver of HIV infections in southern Africa, according to recent research.
PSI is providing technical assistance to Botswana's National AIDS Coordinating Agency (NACA) in an initiative launched earlier this year to raise awareness and eventually change behaviour.
The first phase is a mass media campaign featuring the slogan "o icheke" (check yourself), to get people to recognize the risks of having MCPs. Starting in December, a second phase will target demographic groups most likely to have MCPs with tailored messages, said Richard Matlhare, head of behaviour change at NACA.
"We looked at alcohol as one of the predisposing factors, and that's why the President has taken a stance on responsible drinking," Matlhare said. "We know people can't make informed judgements when they're drunk."
GLOBAL: AIDS funding at "dangerous turning point"
JOHANNESBURG, 5 November (IRIN) - Wavering international support for HIV/AIDS efforts is resulting in funding shortfalls that could wipe out a decade of progress in rolling out AIDS treatment, the international medical and humanitarian organization, Médecins Sans Frontières (MSF), has warned.
In a report called "Punishing Success? Early signs of a retreat from commitment to HIV/AIDS care and treatment", released on 5 November, MSF highlights worrying indications that the two biggest international funders helping developing countries expand their AIDS programmes are starting to scale back or flatline their contributions.
The board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which largely relies on money from developed countries to award grants in 140 poor countries, will soon decide whether to cancel its 2010 call for funding proposals.
If so, it will be the organization's first year since 2002 without a funding round; the total amount of HIV grants recommended for funding in 2009 was 35 percent lower than in 2008.
Countries like Malawi are heavily dependant on Global Fund grants to finance their antiretroviral (ARV) treatment programmes. The MSF report notes that with the Fund in crisis, Malawi's chances of achieving universal access to treatment are sinking.
The US President's Emergency Plan for AIDS Relief (PEPFAR), under the leadership of former President George Bush committed to scaling up treatment from the more than two million people it supports to at least three million by 2013.
Now, faced with an economic crisis, President Barack Obama's administration has flatlined US funding for HIV/AIDS in 2009. In Uganda, a principal beneficiary, some PEPFAR-supported organizations have stopped putting new patients on ARVs.
"We're launching this report because we think we're at a very dangerous turning point," said Dr Tido von Shoen-Angerer, director of MSF's Access to Essential Medicines campaign. "Critical decisions are being made by governments and we're starting to see the early effects on the ground."
After leading the charge for universal access, the UK Department for International Development (DfID) has started redirecting funds to other health issues, while Netherlands is considering a reduction of 30 percent in its HIV/AIDS spending.
"The message five years ago was 'Go for it and we'll support you'," said Dr Eric Goemaere, MSF medical coordinator for South Africa and Lesotho. "Now that we're midway across the river, they seem less sure."
Von Shoen-Angerer was critical of the recent trend in global health policy of pitting AIDS against other health priorities, such as maternal and child health. He pointed out that AIDS was "a continuing emergency" and accounted for more than half of all deaths in five of the countries with the highest HIV prevalence.
"Clearly, there are other global health needs, but it can't be an either-or game," he said. "The dirty secret here, I think, is that donors are getting cold feet about funding a long-term chronic disease."
The decision by some donors to shift funding out of HIV/AIDS treatment and into prevention also created what Goemaere called "a false dichotomy" - for instance, areas like South Africa's Western Cape Province, which had achieved high levels of treatment coverage, were seeing the greatest drop in HIV infection.
Von Shoen-Angerer warned that the cost of treatment was set to rise in coming years. The World Health Organization is considering revising guidelines to reflect research findings that starting ARV treatment earlier improves survival rates and reduces the incidence of opportunistic infections. This could effectively double the number of patients who qualify for treatment.
A growing number of patients will also need second-line ARV drugs, which are currently much more expensive than first-line medications.
MAURITANIA: Don't abandon us, HIV-positive community tells donors
NOUAKCHOTT, 5 November (IRIN) - People living with HIV in Mauritania are voicing their concerns about the suspension of HIV/AIDS funding by the World Bank and the Global Fund to fight AIDS, Tuberculosis and Malaria. They feel powerless in the face of the decisions, of which they are suffering the consequences.
On 14 October dozens of people living with HIV organized a sit-in in front of the World Bank building in the capital Nouakchott to draw the Bank's and the international community's attention to their situation.
"By suspending their programmes without consulting us, donors have not taken our distress into account," Fatimata Ball told IRIN/PlusNews. Ball represents people living with HIV at the SENLS (the national AIDS committee) Executive Secretariat, the government body implementing Global Fund and World Bank programmes.
"We, people living with HIV, did not bring about these problems, so should we suffer the consequences?" she added. "The reason donors give millions to Mauritania is that we are a poor country. They gave us hope of a second life when we had given up on that hope; they should not drop us."
US$21 million of World Bank funding through 2009 was suspended in August 2008 following the military coup against President Sidi Mohamed Ould Cheikh Abdallahi.
Shortly afterwards the Global Fund suspended HIV/AIDS funding, $15 million over five years which was granted in 2006, following suspected irregularities in grant management. An audit in September 2009 confirmed "embezzlement" had occurred, which led the World Bank also to carry out an audit.
In accordance with the Global Fund's terms for reinstating funding the new government, named in September following June presidential elections, began proceedings against four SENLS members suspected of being involved in the embezzlement. The State has also promised to return $1.7 million to the Global Fund and to provide supporting documents on the use of a further $2 million. Finally, the government has also committed to re-structuring the CCM (Country Coordinating Mechanism), the country's Global Fund funding management body; weakness of the CCM is seen as contributing to the problems.
Commitments
While SENLS members recognize the problems that have occurred over the last few months, they are convinced that the new government is keen to resolve the situation as quickly as possible. "The State has made a strong commitment to clearing up the situation. We asked the state general inspectorate to carry out audits and they are now underway," Ahmed Aida, the recently appointed interim SENLS national executive secretary, told IRIN/PlusNews.
"Corrective measures have been taken to ensure things go smoothly in the future. We need [partners] to join us," he urged.
In the meantime SENLS wants to ensure that medical care and support issues are addressed. "The government is willing to take responsibility for treatment," Aida said. In theory, access to treatment is safeguarded under a law introduced in 2007.
The Global Fund have said they are aware of the government's commitment and will do all they can to limit the impact the suspension has on people living with HIV. "We are 100 percent committed not to break up treatments and we will do whatever we can . to continue the grant," Jon Lidén, Head of Communications at the Global Fund in Geneva, told IRIN/PlusNews.
"There is a difficult situation [because of] corruption. but the Global Fund is very committed to continue working in the long term to re-establish a way to deliver services in a safe and predictable way, and to expand them as planned," he added.
The World Bank reaffirmed it is keen to clear up the situation as quickly as possible, but also that they are available to help people living with HIV overcome this crisis.
"We are aware of the urgent nature of the situation and we continue to look after the sick," François Rantrua, World Bank representative in Mauritania, told IRIN/PlusNews. In terms of care and support for new patients, "we are well on our way to finding a very short-term funding solution," he added.
While Global Fund-financed HIV/AIDS programmes have been suspended this has not affected patients who were already on ARVs before the irregularities were discovered - just over 1,000 people have continued to receive their medication; but it has not been possible to add any new patients (totalling around 40 people a month) to the treatment programme.
And other activities in the fight against AIDS funded as part of these programmes have also come to a standstill, such as prevention activities and support (psychological, socio-economic) for people living with HIV.
"We are not against [donors] checking [the accounts] because this will make our lives more secure", said Ball. "But what is affecting us is that things stopped so suddenly. If we had had some warning we would have been able to mobilize to find other solutions. We are already suffering due to AIDS; we don't want to be victims of procedures too."
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