An Open Letter to Africa's Leaders - Joachim Chissano, former president of Mozambique

H. E. Joaquim Chissano is the former President of Mozambique and current co-chair of the High-Level Task Force for the ICPD (International Conference on Population and Development)

Read the original post in its entirety here, at The Africa Report: http://www.theafricareport.com/Soapbox/an-open-letter-to-africas-leaders-joaquim-chissano-former-president-of-mozambique.html

This is a transformative moment for Africa – and indeed, for the world.

Decision-makers from across the continent, under the able leadership of Liberian President, Ellen Johnson Sirleaf, are finalising a crucial document outlining a common position for Africa on the development agenda that will replace the Millennium Development Goals after 2015.

It is a strategy that has empowered us in many ways. And it means that our voices will be heard when the framework that will guide governments, donors and development partners for years to come is negotiated. So we need to be careful what we ask for.

Since the 1990s, Africa has gained considerable strength in international negotiations by sticking together and forging consensus on important issues.

I urge our leaders to draw from the lessons of the past, but also to heed current realities. And to look ahead to what the future is calling forth – because this new development agenda will affect the lives of millions of our people at a very critical time for Africa.

I encourage leaders to take a strong stand for fundamental human rights, and advance the trajectory for basic freedoms.

This means pushing for three priorities that lie at the heart of sustainable development: the empowerment of women and gender equality; the rights and empowerment of adolescents and youth; and the sexual and reproductive health and rights of all people.

These interlinked priorities and their policy implications have been carefully analysed by the High-Level Task Force for the ICPD that I co-chair.

We have found that they represent not only human rights imperatives, but smart, cost-effective investments to foster more equitable, healthy, productive, prosperous and inclusive societies, and a more sustainable world.

Sexual and reproductive health and rights, in particular, are a prerequisite for empowering women and the generations of young people on whom our future depends.

This simply means granting every one the freedom – and the means -- to make informed decisions about very basic aspects of one's life – one's sexuality, health, and if, when and with whom to have relationships, marry or have children – without any form of discrimination, coercion or violence.

This also implies convenient, affordable access to quality information and services and to comprehensive sexuality education.

We can no longer afford to discriminate against people on the basis of age, sex, ethnicity, migrant status, sexual orientation and gender identity, or any other basis – we need to unleash the full potential of everyone.

As an African who has been around a long time, I understand the resistance to these ideas.

But I can also step back and see that the larger course of human history, especially of the past century or so, is one of expanding human rights and freedoms.

African leaders should be at the helm of this, and not hold back. Not at this critical moment.

The international agenda that we will help forge is not just for us here and now, but for the next generations and for the world.

As I think about these issues, I am reminded of the words of our recently departed leader, who gained so much wisdom over the course of his long walk to freedom.

"To be free is not merely to cast off one's chains," Nelson Mandela reminded us, "but to live in a way that respects and enhances the freedom of others."

Let us live up to his immortal words.

• H. E. Joaquim Chissano is the former President of Mozambique and current co-chair of the High-Level Task Force for the ICPD (International Conference on Population and Development)

Read the original post in its entirety here, at The Africa Report: http://www.theafricareport.com/Soapbox/an-open-letter-to-africas-leaders-joaquim-chissano-former-president-of-mozambique.html

"Shuga" is Saving Lives in Nigeria - Mario Christodolou

Read the original post in its entirety here, at The Impatient Optimist: http://www.impatientoptimists.org/Posts/2014/01/Media-Can-Change-Lives-and-it-Can-Save-Lives

MARIO CHRISTODOULOU

January 06, 2014

Sophie has just had unprotected sex with her “Sugar Daddy” (a person who exchanges large amounts of money or gifts for sexual favours). While he goes to freshen up in the bathroom, she innocently snoops around the bedside drawer to reveal a box of pills—little does she know that they are antiretrovirals. She has unknowingly put herself at risk of HIV infection.

The scenario described above is from the new series of the MTV show Shuga, which has now landed in Nigeria. Condensed into this 60-second scene are issues related to transactional sex, negotiation of safer sex, HIV treatment, and HIV disclosure. But this depiction is just the tip of a gargantuan, mass-media behavior-change iceberg.

A scene from Shuga showing Sophie and Solomon in bed. Photo © MTV Staying Alive Foundation

Produced by the MTV Staying Alive Foundation in partnership with the Bill & Melinda Gates Foundation, US President’s Emergency Plan for AIDS Relief (PEPFAR), and the Nigerian National Agency for the Control of AIDS (NACA), the award-winning Shuga TV show has already had two hit seasons in Kenya. But Georgia Arnold, the Executive Director of the MTV Staying Alive Foundation and Executive Producer of Shuga, has a vision for the Shuga campaign in Nigeria that far exceeds anything attempted previously in Kenya.

“Shuga is a ground-breaking TV show that portrays the lives and loves of a group of young people. Seamlessly interwoven into the storylines are vital messages related to HIV and a wide range of other sexual health messages,” explains Arnold. “Alongside the TV series is a substantial mass-media campaign, which reaches our audience at all the points where they interact, improving their access to vital sexual and reproductive health messaging and directing them to the health services they need.”

As well as the TV show, the points of interaction that Arnold alludes to include a radio series, a mobile service (SMS), a comic book (focused on the domestic violence story line in the TV drama, aimed specifically at girls with low literacy levels), digital and social media, and a Skype service through which users can “call a character” from the show and share their thoughts.

Nii and Malaika in Shuga. Photo © MTV Staying Alive Foundation.

“The particular nature of stories and dramas not only deliver informational content but create emotional connections to characters and role models, which promote a better context for learning and behavior change than do factual presentations,” observes Victor Orozco, an economist at the World Bank and coordinator of their Africa HIV/AIDS Impact Evaluation Program. “TV could play an important role in introducing ideas to large segments of a society, especially segments where literacy is low and social norms discourage discussion of stigmatized issues such as HIV/AIDS and teen pregnancy.”

 Shuga series 3 aired for the first time on World AIDS Day, 2013, on more than 70 channels, with a potential audience of a half billion people.By keeping messages from the TV show at the forefront of people’s minds, the introduction of multimedia elements may have the potential to reinforce and promote positive behavior change. For example, sending weekly text messages can significantly increase adherence to antiretroviral treatment for people living with HIV. The Shuga campaign in Nigeria will aim to reinforce the messages of the Shuga TV show with a 360-degree campaign, including several social media and mobile components, such as text messaging and interactive voice recordings. Orozco is working with MTV to evaluate the behavior-change effects of the show and the additional impact of mobile messages through a randomized study.  

A character on the show is tested for HIV. Photo © MTV Staying Alive Foundation.

Shuga has made the journey from Kenya to Nigeria for several reasons. While some might argue that on the basis of prevalence, the need for a campaign like Shuga is greater in Kenya than in Nigeria—HIV prevalence in Kenya (6 percent) is double that of Nigeria (3 percent). However, Nigeria has the second highest number of people living with the disease, and while maternal mortality has significantly fallen since 1990 in the country, one in 13 women still die during childbirth. Additionally, of Nigeria’s burgeoning population of over 150 million, nearly a third are young people aged 10 to 24 years—a population that falls neatly into the MTV demographic and who will relate more closely with stories portrayed in Shuga.

These public health concerns are compounded by a severe lack of knowledge about HIV among young men and young women. “Comprehensive knowledge about HIV is defined as knowing that condom use and having just one HIV negative and faithful partner can reduce the chances of contracting HIV; knowing that a healthy-looking person can have HIV; rejecting the two most common misconceptions about HIV transmission—that HIV can be transmitted by mosquito bites and that HIV can be transmitted by supernatural means," explains Dr Emmanuel Alhassan, Director, Resource Mobilization at NACA. “However, only 22 percent of young women and 33 percent of young men [in Nigeria] have comprehensive knowledge about HIV.”

Shuga has the potential to displace the silence that has engulfed serious issues like HIV in Nigeria and beyond, and to fill the knowledge vacuum that such silence has created. Shuga series 3 aired for the first time on World AIDS Day, 2013, on more than 70 channels, with a potential audience of half billion people. With this kind of reach, the ability for this so-called entertainment education to inform, change attitudes, and even change behavior is undeniable.

However, Orozco notes that policy makers and funders might be seriously under-investing in such mass-media approaches due to lack of rigorous evidence. But with the support of the Gates Foundation and MTV Staying Alive, he and other researchers are remedying this by evaluating Shuga and creating a knowledge base of what methods works and what is worth scaling up in Nigeria and elsewhere.

“Our vision for Shuga is to see a transformation in attitudes about the way the world talks about sex, not as a dirty topic, or something that should be hidden, but something that is openly discussed: parent to child, peer to peer,” envisions Arnold. “Only by doing this will we see a real change in people’s attitudes about HIV and their knowledge about it. Only through open and honest dialogue can we can hope to save lives.”

Find links to the episodes that have aired so far here. 

Read the original post in its entirety here, at The Impatient Optimist: http://www.impatientoptimists.org/Posts/2014/01/Media-Can-Change-Lives-and-it-Can-Save-Lives

An Interview with "James" by Brian Fuss

The following is from an interview with James (not his real name) an HIV+, gay male, sex worker, pro-Dom, and former drug user.  Thank you for sharing your story, James.

James grew up in a Midwest town Pentecostal family where religion and family were constantly reinforced by their twice a week church attendance. James remarked, “All of my friends were from that church; in fact, I did not know anyone other than church members.” At the age of 16, after struggling with his sexuality “forever,” James shared with his older sister about being gay. James stated, “My sister betrayed me and told my parents and this ensued a shit storm in my life.” His parents demanded he “repent of his homosexual, evil ways and go back to loving the Lord.” However, James knew he could not deny who he was, and told his parents as much. His parents threw him out of the house until “he properly repented and served the Lord.” Alone, hungry, scared with his last $100.00, James went to LA hoping a friend would help.

“The friend was a total asshole and basically had sex with me for a few days and then told me to beat it.” Now, completely alone, in a strange city, and frustrated, James had no idea what to do. Then, a kindly man offered him a warm bed and food. “He was a nice guy…at first he said I could just hang out until I got on my feet. Then he started to flash around a lot of money. When I asked him what he did, he said he worked in the porn and sex industry. This was more money than I saw in my whole entire life.” He became James’s mentor, telling him what porn shoots to go on and what places to stay away from. “The way to make more money was to do it (sex) raw (bareback), so of course I became that type of actor. I was making a lot of money between this and my lucrative escort business. With that came the partying, more sex, and HIV.”

“HIV completely changed my life. First, it [HIV positive status] got me into recovery.” James explained he left partying and entered (drug and alcohol) recovery and has been sober for 5 years. “Being an escort brings its own stigma, but it, honestly, is something I do not have to self-disclose, unless I want to date you…there is the rub…most guys are completely intrigued by my sex work, but hesitate to get involved with me because of it. I have heard numerous times…you are a great guy but I can’t be with (date) a hooker…I ain’t no hooker!” James further explained that HIV is the second hurdle that creates a lot of stigma in his life, both professionally and personally. “I have an obligation to tell clients, if they ask, about my HIV status (James explained he is 80% safe with clients and is undetectable) if they want to fuck raw.” James stated he has been single because no one wants a “HIV positive sex worker for a boyfriend, and that just hurts.”

I asked James two question, which I believe are important and pertinent to the discussion of stigma and I offer James’s answers in their entirety.

Many profiles on gay dating sites have the terms clean and dirty to describe someone who is HIV- verses someone HIV+. What are your thoughts? “I’m not dirty! When I see that shit, I just get pissed and usually say someone. Gay men can be so pathetic when it comes to HIV status. Think about the terms…because I am HIV+ I am somehow defective and should be ignored or worse cleaned up…it reminds me of what my parents said when they threw me out of the house…maybe I am just dirty.”

What is your advice to other young men in a similar situation? “You are more than your status, the drugs you take or the work you do! Don’t let anyone take your humanity away from you!”

In conclusion, James tells a story of stigma and shame from growing up gay in a Midwestern town to being a sex worker to being in recovery to being HIV+. It is estimated that more people delay treatment or refuse to get tested out of shame and stigma, especially if they are involved in the sex industry.

_ _ _ _ _ _ _

This interview was conducted by Brian Fuss of the Harm Reduction Coalition 

Breaking Down Barriers: Addressing HIV Stigma in Health Care Settings by Betrand Audoin, Executive Director of the IAS

Bertrand Audoin is the Executive Director of the International AIDS Society (IAS) and a member of the Stigma Action Network's Steering Committee. He has been working in the HIV field for almost 20 years, and first became involved in the response to the epidemic at grass roots level in the early 1990s. For more information about Bertrand read his full IAS bio here.

_____________________________________________________________________________

Given that the International Congress on AIDS in Asia and the Pacific (ICAAP11) – in Bangkok is soon upon us I’d like to do a follow up to the New York Times opinion piece I wrote a few months ago on the impact of homophobic laws and discrimination following the recent murders of a transgender youth and a gay man. 

The issues of stigma and discrimination can also be deeply felt in health care settings too. People are more likely to use health services if they are confident that they will not face discrimination; that their use of services will not expose them to other risks, such as detention due to their criminalized status; that their confidentiality will be maintained; that they will have access to information; and that they will not be coerced into accepting services without consent. 

Many reports reveal the real existence of the discrimination that many people living with HIV/AIDS experience in health-care systems, including  differential treatment; the denial of treatment; HIV testing without consent;  breaches of confidentiality and  refusal of treatment – refusal to provide medical services to people living with HIV.

Women living with HIV/AIDS experience double discrimination in health-care settings. Reports indicate that pregnant women are routinely tested for HIV without their knowledge, much less informed consent to the procedure.

In India, spouses of all HIV-positive men are advised, and sometimes forced, to undergo HIV testing whether seeking medical care or not. HIV testing is also administered as a rule to all patients prior to surgery and in cases where a suspicion of HIV arises based on their physical appearance or belonging to a high-risk group, such as sex workers. Generally, such testing is mandatory, no consent is provided and there is no pre- or post-test counseling.

It is truly unacceptable that reports are still revealing that 29% of persons living with HIV/AIDS in India, 38% in Indonesia and over 40% in Thailand say that their HIV-positive status had been revealed to someone else without their consent.

This stigma and discrimination towards people with HIV can lead to a vicious cycle with well documented negative health implications ranging from increased depressive symptoms to engaging in risky sexual behaviour.

We’ve long known that there are three main causes of HIV-related stigma in health facilities: a lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behaviour.

At the IAS we strongly believe that HIV professionals, whatever their level and field of engagement and action, can play a pivotal role in breaking down barriers and contributing to achieving universal access through a human rights framework. They are a key entry point for promoting and implementing change and preventing situations of abuse and dysfunction in a wide range of settings

The IAS has a two pronged approach to its work with HIV professionals:  ensuring that health care providers and HIV professionals are aware of their own human rights AND enabling HIV professionals to realize rights based approaches and attitudes in all work they undertake both in and outside of provide health care settings.

The IAS also aims to equip HIV professionals with the skills and tools necessary to ensure patients’ rights to informed consent, confidentiality, treatment and non-discrimination and  to also build their ‘legal literacy’ by improving their knowledge of human rights and the national and local laws relevant to HIV.

I am convinced that building both the knowledge and capacity of HIV professionals will empower them to become agents of change and enable them to provide the highest available standard of care to people living with, affected by and at higher risk of becoming infected with HIV.

I look forward to my colleagues at the Stigma Action Network reporting back on their own workshop at ICAAP 11 as well as their impressions of the more generalized discussions around the issue at the conference.

International Day of the Girl

International Day of the Girl encourages us to draw our attention to the inequalities facing young girls across the world. We are called to take a critical look at whether or not girls are given the same opportunities as boys in terms of access to education, financial stability, and sexual empowerment. Here at the Stigma Action Network, we are most concerned with how girls are affected by the HIV epidemic. After examining the data related to this topic, we ultimately found that:

• In sub-Saharan Africa, young women aged 15 to 24 are up to 8 times more likely than young men to be living with HIV.[1]
• Worldwide, young women account for 66% of young people living with HIV.[2]
•  Women living with HIV are more likely to experience violence as result of their status, than men living with HIV.[3]
• Prevalence of first forced sex among adolescent girls is as high as 48% in some countries, which further maintains the HIV epidemic.[4]

While these facts are indeed surprising, the factors that perpetuate them are even more alarming. Three of these most significant factors are outlined below.

• Girls’ Lack of Empowerment: According to global statistics, girls are significantly poorer, less educated, and as a result less financially and socially empowered than their male counterparts. This power imbalance reduces young women’s choices as they negotiate their sexual health and relationships, often giving them little choice in determining if and when to have sex, and in cases of consensual sex, whether that sex is safe. Furthermore, poverty prevents underprivileged girls from receiving adequate health care and education, and as such resources are essential in fighting the HIV epidemic, breaches in these areas may lead to HIV infection.

• Biology: The risk of becoming infected during unprotected sex is two to four times greater for women than for men, and for young girls, the risk can be even higher.[5] This biological disparity gives further evidence as to the importance of educating girls about their sexual health and rights, specifically as they relate to HIV.

• Culture: And lastly, cultural mores may encourage men to have many sexual partners.[6] This is particularly problematic surrounding the issue of child marriage, as such customs can facilitate the spread of HIV to girls in high-risk areas. And given that one-third of the world’s girls are married before they reach the age of 18, such practices can have quite widespread and devastating effects.[7]

As you can see, there are a multitude of socio-economic and biological factors that put girls at a higher risk of HIV. But what is the solution to this problem? And how can we curb these inequalities and give girls the power to take control of their sexual health?

Carol Bellamy, Executive Director of UNICEF offers up her thoughts:

“Education is crucial to success against the pandemic. 

In fact, UNICEF remains convinced that until an effective remedy is found,

 education is one of the most effective tools for curbing HIV/AIDS”

Luckily, the following organizations are contributing to the fight against HIV by educating girls about the importance of and how to protect themselves by engaging in safe sex! Here are a few #StigmaWarriors who are doing great work with girls on HIV education:

Girls Learn International, Inc

Girls Learn International, Inc. takes a unique approach to girls’ education by partnering American schools with schools in foreign countries where girls do not enjoy the same educational opportunities as boys. This organization functions as an after school program that offers service oriented learning to young girls. Participants in the US chapters learn of the challenges facing girls in their partner schools including child marriage, trafficking, poverty, sexual health, and educational disparities. Money that is raised domestically goes towards purchasing textbooks, teachers' salaries, meals, and transportation in partner schools. Girls Learn International, Inc. has 47 partnerships in the following countries where HIV rates are notably high: Afghanistan, Bangladesh, Cambodia, Ghana, India, Kenya, Nepal, Pakistan, Tanzania, Uganda, and Vietnam. Learn more about this organization and how you can help support the education of girls across the world. 

Maasai Girls Education Fund

On the Top 10 list of countries most affected by HIV/AIDS, Kenya comes in at #4. Girls living in poverty have less control over their sexual health, both because of lack of education and because of sexual abuse. "A large, national survey of secondary school girls in Kenya found that 40 per cent of those reporting sexual activity indicated that their first sexual experience was forced or that they were 'cheated into having sex.'"[8] The Maasai are nomadic pastoralists originating from the lower Nile valley with a strong traditional culture that often prevents females from receiving an adequate education. Only 48% of Maasai girls in Kenya enroll in school, and only 5% of those who enroll reach the secondary school level.[9] Such educational disparity can further facilitate the spread of HIV, as girls who remain uneducated are not only unable to make sexually sound decisions, but are also unable decisions that may secure a promising future. The Maasai Girls Education Fund works to combat this, however, by providing a safe environment where girls can receive a quality education. Donations to the Maasai Girls Education Fund go towards buying uniforms, books, and helping to pay tuition. What makes this organization stand out are their community workshops that attempt to reverse cultural beliefs and norms that discourage young girls from enrolling in and committing to school. And as enrollment in school is the best HIV prevention method available to girls (as noted by the World Bank), this organization’s work can surely make a difference.

Commit 2 Change

Young women are the victims of heavy abuse in India as well, in part because they are viewed as the less desirable of the two genders: over 25,000 of adolescent girls are malnourished and suffer from illness and medical neglect [10]. Commit 2 Change is dedicated to supporting female orphans in India by providing them with secondary education, with a particular emphasis on sexual health and HIV/AIDS prevention. Millions of children across the world have become orphaned after losing their parents to HIV/AIDS. Orphaned children are more likely to become impoverished and less likely to be enrolled in school as a result. A study done by UNICEF reveals that "the irony is that orphans are frequently deprived of quality education, which is the very thing they need to help protect themselves from HIV" [11]. India ranks #3 on the Top 10 countries most affected by HIV/AIDS.

The SAN congratulates the above-mentioned organizations (and others around the world!) who are doing great work to educate girls about safe sex and to prevent the spread of HIV among this particularly vulnerable population. However, The Girls Insights report conducted by the International Center for Research on Women found that "girls said they still lack even the most basic knowledge, autonomy and other assets critical for their health and empowerment." This demonstrates that even more must be done if we are to stop the spread of HIV and related stigma!

We hope that more organizations accept the challenge of incorporating sexual education, including education around HIV, into curriculum for young girls and adolescents. Programs must also be developed in a way that empowers girls to use this education to make sound decisions about their own sexual health. Together, with this sort of integrated approach, we can help girls gain control over their lives and futures, and help make a future without HIV a reality.

(Visit UNICEF for more details.)