Orga, the first woman under anti-retrovial treatment at NTASEKA Clinic with her (HIV negative) daughter. “I was almost dead, but God has used FWA to give me back life.”
This Report from Kenya explains what is needed to deal with HIV/AIDS in Africa. It is commonly assumed that the introduction of free (to the patient) anti-retroviral (ARVs) drugs is sufficient to contain and control the disease. Unfortunately this is only one of numerous necessary conditions to deal with AIDS. I will be using the experience of the Friends Women’s Association’s Ntaseka Clinic in Kamenge, a slum in Bujumbura, Burundi, to indicate the various additional conditions needed.
The Ntaseka Clinic began in 2002 when ARVs were still unavailable in Burundi. It was not until 2010 that the ARVs became cheap enough for them to be supplied and used in a poor country such as Burundi.
Yet the drugs have requirements that are sometimes difficult to find in Africa. First there must be the machines needed to test the viral loads of those who have tested positive for HIV. This requires electricity. Since the drugs also need to be refrigerated, it is necessary to have a refrigerator. But electrical power is often intermittent in Africa, sometimes off for short periods, but other times for hours or even days. Consequently Ntaseka Clinic needed a back-up generator and the necessary recurrent funds to buy diesel.
Then the staff needs to be trained in the use of the equipment, when and how ARVs should be used, and understanding the disease itself. This though is not sufficient because after HIV testing, when people are told that they are HIV+, many become despondent and depressed. Therefore the Ntaseka Clinic has a counselor who works with those who have being tested. For example, in May, of the 330 tested for AIDS, 12 (or 4%) were found to be HIV+. At the end of June, the clinic had 234 people receiving ARVs including 176 women (75%) and 49 men (25%); it is common for the HIV+ rate to be much higher in women than men.
This concludes the medical aspect of the disease, but there are many other necessary conditions. The first is that the ARVs are only effective if the patient has adequate and nutritious food. In a slum like Kamenge this is not always the case. As a result since the beginning of the clinic in 2002, the clinic has given food assistance, usually of rice and beans, to the people who are HIV+. Needless to say, even though the supplements are not sufficient for adequate food intake, the current amounts given are quite an expense for the clinic.
Community meeting to encourage people to be tested for HIV and to promote family planning.
When the clinic was started in 2002, HIV/AIDS was a taboo subject since anyone who had the disease was considered to have “sinned” through extra-marital sex by one of the couple contracting the disease. Since at that time AIDS was essentially a death sentence, people who had the disease were ostracized and as a consequent keep this positive status a secret. I remember in 2005 when Felicite Niyonzima was the first Quaker in Burundi who was willing to publicly admit that she was HIV+ and willing to speak about it in front of large groups of Quakers. When with her help we conducted the first three-day Healing and Rebuilding Our Community (HROC) workshop with HIV+ women – including an extra day for healthy living needed at that time to survive without ARVs – we found that the participants were so relieved to be able to discuss their situation and meet with/listen to others with the disease. (Note when I last saw Felicite in 2014, she was still doing well and her daughter was not HIV+). Today the Ntaseka Clinic continues to conduct HROC workshops with the women who are HIV+.
One of the clinic’s self-help/support groups for HIV+ women.
Yet again this is not sufficient. The clinic puts the women into self-help/support groups of around ten each. In these groups the women discuss their positive status, support each other, learn from each other and the staff how to live a healthy lifestyle, and then becomes part of a self-help group. The group then gives the women funds for income generating projects so that they have an income to take care of themselves and their children.
HIV/AIDS testing during a community awareness campaign.
If the disease is going to be managed, people need to know their status by coming to the clinic to be tested. Since there is still an AIDS stigma in Burundi and people are reluctant to be tested, the clinic conducts AIDS awareness campaigns (along with family planning awareness) in the Kamenge community. This is how they get so many people to come to the clinic each month for testing and then enroll those who are found to be HIV+ in their services.
Participants in a gender based violence basic workshop was done in Giheta commune, Gitega province with a total of 20 participants, including 10 religious leaders and 10 community elected leaders.
Then another issue arises. Women are infected as such a greater rate than men because of gender based violence and the sex work that desperate women do for income. Therefore, if the disease is going to be managed, there has be less gender based violence and female sex work. This means conducting workshops on gender based violence with men including government officials. The workshop includes teaching them to become gender based advocates.
In a larger context, AIDS will only be contained when a country is peaceful. During periods of violence, women are raped, sometimes gang raped, which infects them with HIV. Moreover if you follow the African news as much as I do, there are frequent pictures of people fleeing violence – some have pictures of women carrying whatever they can on their heads. If people are HIV+ and receiving ARVs, then their flight interferes with receiving their medications on a timely basis. This is detrimental to their chances of survival. Another large context is poverty. If women feel that they need to do sex work, if they are unable to eat enough nutritious food, if they are forced to remain in abusive relationships with men due to lack of other viable options, they will more likely become HIV+. The Friends Women’s Association has the dream of developing a safe house for abused women and their children.
Setting the lines for digging the foundation at the maternity ward.
There is always another step. There are going to be HIV+ women who will become pregnant and it is important that they do not convey their positive status to their children. In a slum like Kamenge, most women give birth at home with minimally trained midwives and the possibility for HIV+ mothers to convey the disease to their offspring. The Ntaseka Clinic has now begun the construction of a maternity ward in order for women to give birth a hygienic place with professionally-trained staff.
In summary, this report illustrates how the medical response of ARVs is only one step in containing and hopefully reducing the prevalence of AIDS in Africa. In addition, a society needs to be peaceful, food secure enough that people can eat properly, and reduce gender based violence as much as possible. Taken all together these are Herculean tasks.
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