Sunday, May 31, 2009

The Role of International Organizations in the HIV/ AIDS Epidemic in South Africa

It is ten in the morning on a crisp day at the Valley of a Thousand Hills.  A child screams, tears running down face, complaining of a headache.  A caretaker runs to the aid of the child fearing the worst, a high temperature next to the back of her hand, a fever.  For some, this is easily solved by the comfort of swallowing a speck and knowing an acetaminophen pill will cure the illness.  In South Africa’s orphanages this means the fear of having a child with HIV under care.  Not that the moral and ethical grounds of this aren’t humbling, but the fact that having scarce resources and an almost non existent transportation system, gives the child an advanced death sentence… 


            To a much popular misconception, the Human Immunodeficiency Virus or HIV does not kill.  This virus, a lentivirus from the retrovirus family can lead to the acquisition of an immune deficiency syndrome, AIDS (acquired immunodeficiency syndrome).  People who do not have this syndrome may go about their day having a common cold or even an infection, whilst those with AIDS can be bedridden on the verge of complete failure of their system.  Some fear HIV to be highly contagious which has caused HIV to be feared as an airborne pollutant, which serves as the beginnings of a new xenophobic perspective on those who are carriers of the virus.  The truth is that HIV’s transmission is reserved through three main routes.  The first and most common is via sexual intercourse.  Having unprotected sex with an HIV infected partner means that when his/her infected sexual secretions come in contact with the genital, oral or rectal mucous, the HIV sexual transmission is occurring.  Another form is through the blood system.  When an HIV infected blood drop comes in contact with a non infected blood system, the once healthy one will become a carrier of the virus.  The most common cases have been noted to be the sharing of needles by drug users, poor hygiene where intra venal exchange takes place (including blood banks and other medical care).  The third one is the saddest one of all, it’s known as the MTCT or mother to child transmission.  If not treated, MTCT has two main chances to take place and a thirdly not so commonly discussed.  The first way is known as in utero or during a pregnancy, the second is known as intrapartum or at childbirth.  After the child is born, through a treated pregnancy and undergone C-section, the mother can still transmit HIV to the child via breast feeding.


            The fact that HIV has been diagnosed in more than 46 million people around the World since 1981 (when it was first recognized), makes this shunned “African Epidemic” into a fear-respected pandemic.  The fact is that this pandemic holds fort in specific areas of the World which are mainly reserved to sub-Saharan Africa.  It is here where 27 million people of those 46 million people living with HIV are found.


            South Africa is not just the sub-Saharan country with the highest number of people living with HIV.  It holds as well that same record for the World demographics.  But, why a country like South Africa, rich in resources, a newly incorporated democracy and a country “on the rise” race is dealing with an epidemic such as this one?  Is it perhaps government denial for compelling control or is it mere ignorance? Perhaps the teachings of ethical discipline by missionaries is the very cause of this descent into a backwards and still road? 


            There are limited choices for people that are infected with HIV in South Africa.  This is not because no vaccine has been invented, or there are no antiretroviral drugs.  The fact is, that in cases where the Government fails to understand and act, popular misconception becomes popular disadvantage.  Most, with no means of attaining an antiretroviral rely on their culture for hope.  A South African custom by Zulu witch doctors is to tell persons that carry the HIV/AIDS illness to sleep with a virgin.  This in time relieves one of the ill filled Spirit within you due to the fact that it disintegrates with the contact of pureness.  South Africa’s former Health Minister, Mantombazana 'Manto' Edmie Tshabalala-Msimang won her international dislike and concern when she proposed treating the AIDS epidemic with ‘Two veg’, a combination of a plate of vegetables containing garlic and beetroot instead of antiretroviral medicine.  If it’s not enough the president elect of South Africa Jacob Zuma of the ANC (African National Congress) is said to have slept with a friend’s daughter which was a carrier of HIV and then showered in baby oil to “wash down” the possibility of contraction.


            Manto’s lack of credibility and delivering substantial facts on HIV/AIDS has led greatly to the decay of social and economic order in South Africa.  When on the 25th of September, 2008 holding office president Kgalema Motlanthe designated Ms. Barbara Hogan to the head office of Health Ministry, the unheard and dismissed doctors along with HIV/AIDS researchers saw a ray of hope.  Perhaps now, with a person that holds strong bonds with the AAF (Amandla Aids Fund) and the South African National AIDS Council in chair, progress could be made.  On December 1, 2008, AIDS Day, South Africa’s incumbent health minister Ms. Barbara Hogan delivered the message that since her appointment of office in Septemer 25, 2008, the country is now committed to implement the National Strategic Plan for HIV and AIDS.  Which means the setting of goals as to reducing shameful demographics that reflect the viruses work.  She also stated “…we must become organized and demonstrate urgency”.  Indeed it must be done.  But perhaps a first issue might be the root of all discordance in a seemingly positive action.  Perhaps the answer lays in settling as to what is morally correct and what is implemented as well as educated by the organizations that have been running solo (without plausible and beneficial government collaboration).


            This essay will focus primarily on four international organizations.  The first three are known worldly as standard international organizations.  These are, the World Bank (WB), the World Health Organization (WHO) and Amnesty International.  The fourth one is not commonly known or even thought of as an IO, but in this case it should.  After all, one book defines an international organization as a charitable organization that provides services either exclusively or in a substantial preponderance to people in non-domestic areas.  This International Organization is the religious sector, which sets a preponderance of missionaries on a religious mission to spread and at the same time help the needed.


  The World Bank addresses the HIV/AIDS epidemic in South Africa mainly as a researcher for publications and data reports.  They model the costs and consequences of programs, view the demographics and outline the more and not obvious tendencies that make and deprive social and economic order when it comes to HIV/AIDS in South Africa. 


The HIV epidemic in Africa plays a major role in the economy.  When a person has contracted HIV, which in turn is diverted into AIDS, the economy weakens.  Imagine this happening by the millions.  This entangles an impact in the microeconomic sectors such as schools, education and households among others, which in turn, cycle into a whirlpool of downfall in macroeconomic terms.  When studying HIV/AIDS and how it affects the economy, it’s often better to start with the demographics.  In terms of population pyramids, South Africa’s is considered to be a rapid growth pyramid, which explains that life expectancy is short, there is a high birthrate and there’s barely any workforce (relating to the ages between 15-49).


            The economic impact of these numbers start off in a micro form, mostly affecting households.  When a person is diagnosed with the disease, families and friends get affected both emotionally and economically.  It is not only the loss of a person because of AIDS meant that there was one less income in the household, being infected meant that the chances of finding a job were slim to none, making the latter a likely outcome. The loss of an income bearer makes the burden fall on the surviving members of the household in terms that duties are re-distributed, and expenses are increased depending on the ratio of adults to dependents.  If a heterosexual husband is diagnosed with the disease, chances are that his spouse may be infected as well, making this a greater threat to the family and income.  This is also a problem in population terms, since an increasing 59% of people diagnosed with HIV are women. Mothers-to-be may pass it to their child, which increases the chance of these children, falling into their kin’s fate. This results in a reducing life expectancy along with a decrease of fertility rates, following a lacking of labor/work force in the years to come and eventually affecting the macroeconomic side of the equation.


            The lack of a work force increases debt by the millions.  The debt in sub-Saharan Africa increased from $6 billion in 1970, to $60.9 billion in 1980, to $176.9 billion in 1990 to a major debt of $231.4 billion in 2003.  In the rural areas, the loss of labor, events in the increase of auto-subsistent families, which means a loss of export which in turn increases imported goods.  The unbalance of imported good versus exported goods tips off the nations economic reserve into a downfall of collective debt.  Industrialized areas such as major cities experience the absence of a work force by the change in the supply and demand they tend to.  Also AIDS damages businesses by squeezing productivity, adding costs, diverting productive resources, and depleting skills. The disability of African businesses to diversify, attract foreign investors, which are integral to an economic progress. With the loss of a work-force, labor becomes more expensive, reducing profits.   AIDS limits the ability of African countries to attract industries that depend on low-cost labor, which makes investments in African businesses less desirable. HIV and AIDS therefore threaten the foundations of setting economic and social progress in Africa.  All of this in turn is taken into account, and stretched malleably in order to organize and help the HIV/AIDS response programs.


            The World Health Organization meddles in the prevention and control of HIV/AIDS along with basically every other organization willing.  This includes, United Nations Agencies (what is UNAIDS), Health Ministers, NGO’s (Non-Governmental Organization), Development Agencies (what is Habitat for Humanity), and other.  They have a set list of active programs mostly constructed with a continental sense in mind, but nevertheless applicable to South Africa.  The list is called the five (5) strategic directions, which includes the goals of their programs.  These are, (1) to enable people to know their HIV Status, (2) maximize the health sector’s contribution to HIV prevention, (3) accelerate the scale-up of HIV treatment and care, (4) strengthen and expand health systems, and (5) invest in strategic information to better inform the HIV response.  Unfortunately this plan of attack ignores existing regional aspects.  Say denial from political figures as mentioned in the latter.  Or lack of transportation, which enables a successful expansion of a health system.  WHO’s June Progress report of 2008 ‘Towards Universal Access’ promotes “…to decentralize services, and to delegate tasks to less specialized health workers…”.  Is this really the answer?  To have a continuous development of a non qualified group serving the special needs of fragile HIV/ AIDS victims?  In developing and transitional countries, 9.7 million people are in immediate need of life-saving AIDS drugs; of these, only 2.99 million (31%) are receiving the drugs.  What about the third world countries?  What about the data that has not / could not be collected?  Is it possible perhaps that even though this type of Organization draws up a major plan for trumping the HIV/AIDS fight, that the handle on it might be to widely loose?  There is a secret goal behind every major organization, one that captures the approval of people and motivates its members.  Usually this goal will dictate a percentage and a time span.  For South Africa, the goal is to reduce HIV victims by half in three years time:  a mighty goal to be reached with so many deficiencies to be corrected.  While there have been lives touched, medicines delivered and joyous good news at many points of its programs, more is needed to be done and a more crude realistic approach is needed to be exhorted.


            We also find ourselves with organizations that take on a more humanitarian approach.  Such is Amnesty International.  Their thoughts are that human rights are fundamental in addressing the HIV/AIDS Epidemic.  They state that when there is a violation of human rights, the epidemic is further fueled by the increase of the vulnerability of the people.  They also state that, “…people living with HIV and AIDS can be subjected to various forms of discrimination and ill-treatment, including harassment, arbitrary arrest and torture…” Amnesty International calls upon on regional governments to fulfill the international commitment to the right to health, remove funding conditions that inhibit the prevention of HIV and AIDS, ensure equal access to treatment, ensure access to information, guarantee sexual and reproductive rights, safeguard women's rights and stop violence against women, ensure participation of people living with HIV and AIDS, share equally the benefits of scientific progress, affirm the right to privacy and confidentiality, and ensure monitoring and evaluation for human rights and evidence-based solutions.  In South Africa, plans to strictly follow this ten goals program are paused and deeply inhaled in slight desperation when the headlines come in.  Headlines that report on how the violence against women is climbing, the rates of rape and murder show with strong appearance.  How there’s nowhere to shelter, how HIV/AIDS survivors are still at risk.  On where there is a lack of transportation, there is a lack of treatment.  Amnesty International works close and with other organizations and their data.  On the most part, all the organizations involved have a set of goals, which are slightly similar, a set pattern for the same problems.  It should be fair to mention on another note that many organizations develop programs that tend with an immediate response, sadly a lot of them have a time lapse in a region before moving on.  So while one organization may develop an educational program on HIV/AIDS, a treatment center or a community labor project, if not continued to be tended by the members of that community, such programs will pack up and move along in a few years time.  Hence comes the expression “give a man a fish and he will eat for a day, teach a man to fish and he will eat for a lifetime”.  If said organization programs were to educate the people on how to continue the programs.  Education on a rooting level, instead of a temporary one, then regional mainstream problems would eventually become more controllable. 


            The fourth international organization is the religious sector.  Unconventional yes, however this organization is not an epiphenomenal one.  It plays a major role in the theme of HIV/ AIDS in South Africa as this organization preaches beliefs that dictate the daily lives of people.  The distribution of religion is very obvious, and according to data collected by the CIA’s 2001 Census, published in its World Fact Book, it’s distributed in the following manner; 75.90 percent of South Africans are members of the Christian religion or one of its branches, 3.8 percent are Anglican, 1.5 percent are Muslim, 3.7 are from other unspecified religions and 15.1 percent have said not to be affiliated to any religious entity.  In this essay we mainly want to focus on the Christian community as it holds the largest percentage of members. 


            Since the arrival of the Dutch in South Africa in 1651, Christianity has had great importance in conjuring relationships between Africans and Europeans.  It all started with the interaction of European missionaries and African chiefs and commoners.  As some Africans made Christianity their own, conversion then became a central action in cross-cultural interactions and played a major role in the expansion of European domination across the southern part of the continent.  We have to acknowledge this as an important actor in the populations ideas and beliefs, thus it represents South Africa’s past and present.  


            For years, Christian health missionaries have worked in community-based initiatives to comfort AIDS patients in Africa by combining preventive and clinical care services with high concerns for the spiritual health of individuals and communities.  There is yet no official data that shows demographics directly connecting affiliates of the Christian church (or any other religion) as patients of HIV/ AIDS.  However, a study started in 2006 (and to this day still on-going) by the University of Harvard, which constitutes a series of questions for HIV/AIDS patients in South Africa shows the following tendencies; that patients diagnosed with HIV are mostly Zulus, that they are mainly women who decided to get tested because their partner was diagnosed with HIV, that they have never been tested before, that they belong to a branch of the Christian church, that they live with three or more relatives, that their parents are deceased, that they have more than three children and have lost at least one to an HIV related cause. 


            Among the teachings of the Christian missionaries, communities under their trusteeship don’t approve of the use of prophylactics due to the fact that they prevent God’s will for a person to conceive.  As well as promote sex as a pleasure action instead of that as copulating for procreation.  The allowing of abortion when it comes to a child bearing woman who wishes it so is also a struggle within South Africa’s HIV society.  The women patients who bear HIV come to have it consequently for one of the following reasons.  Living in a patriarchal society, women are afraid to deny coitus to a husband whether he has HIV or not.  They were born with it as it was passed from their mother during the pregnancy, the birth or lactating period.  They were victims of rape.  The Christian community promotes forgiveness and the withstanding of the conceptual “family”.  This puts women victims in a position between loosing a place in their family and having an entire community turn their back on them.  Through thought or suggestion, the Christian church leaves a mental impression on its members that promotes the mentioned course of action which creates the latter problems.


            According to the United Nations Program on HIV/AIDS (UNAIDS), at least 34 million Africans have been infected with HIV. More than 95 percent of all new HIV infections, including prenatal infections, occur in Africa. The UNAIDS estimates that 11.5 million Africans have died from AIDS, and that there are 5,500 funerals a day. Ninety percent of all AIDS orphans are African. Although the World Bank, the UNAIDS, and WHO have come up with “strategic plans,” “action plans” and “programs of action” for reducing the rates of HIV/AIDS in Africa, real solutions must also include an African-based government who accepts reality, is open to develop programs and accepts knowledge and help from foreign actors.  The global response should not be an “aid” program but rather should become a steel triangular partnership between the international community, national governments, and community-based NGOs which will all work together to include clinical/health as well as educational programs.  As Jean Jacques Rousseau once said “le développement d'enfant dans l'éducation reflète l'évolution de la culture” (child development in education mirrors the evolution of culture). 


            … the options are not much.  Finding enough fabric to carry the child in the back and starting a three days walk to the nearest hospital will leave the orphanage extremely understaffed.  The advice given by political superiors such as a meal of vegetables only works on filling the child’s hunger for a day.  The witch doctor in the next village will surely conjure a potion from flora and recite ancient passages, which will eventually scare the illness away.  The child curls up tightly, finding both comfort and hope in the arms of a complete stranger. 

Monday, May 25, 2009

The Love Dance

And he saw her across the room dancing passionately to the rhythm of the guitar. Her eyes were closed as though the music was making love to her, filling her hungry heart and soul. He thought of her lips on his body, of their taste, of the sweetness that would conquer his heart. He wanted her to dance like that night forever. While she danced, she smiled to herself and his mind was filled with desire to know the secrets she kept, the secrets she smiled to, to know the rhythm in which she lived. He wanted to bring her the same pleasures the music brought her. And when she opened her eyes, he saw a blinding light so intense that he would remember forever. That light cast a spell that night. From that moment on he knew that if she wasn’t his, life had no meaning. His breath belonged to her and her eyes were his only sight. He wished of touching her with his hands, of feeling her movements on his body and yet his only wish was that her eyes wandered and rested on his. “I am filled with poetic love, and you are the reason” were the words he whispered to himself. His mind went into a trance and saw her next to him, on top, all over him. Her kisses were like hot water upon his lips. She was an art, a masterpiece, a symphony without end. The touch she gave was soothing, erotic, passionate. He embraced her wanting to never let go, and she smiled her captivating smile and kissed him on the cheek. A kiss so passionate that it whispered…eternity, she had kissed his soul when she kissed his body. Slowly she began to fade, but somehow her loved remained, her touch was present, her breath was hot over his, her movement and her rhythm were still intense. As he opened his eyes he noticed it was a dream, the dream that gave way to his destiny. He turned and saw her next to him sleeping, glowing like an angel, his angel. She had the smile he couldn’t resist, the smile that made him fall in love with her. He knew all her dreams and this one was her favorite. He took her hand and kissed it, leaned over and whispered in her ear “I am filled with poetic love, and you are the reason”.

Life Lessons

Forgive people when they ask for forgiveness, this doesn’t mean that you will give them your complete trust in the blink of an eye, it means that you accept the fact that others (same as you) make mistakes.

Be strong, even when your heart crumbles inside you, this you do, not only for your sake, but also for those around you.

As much as you deny that you have hope in someone, you cannot escape having it. Don’t beat yourself up because you might think you live in denial or stupidity, this means, that you have faith.

Be capable of loving.

Respect everyone, and you shall learn from them.

Imagine through your dreams, you will figure out the ways to reach them. But be patient, all will come in it’s own time. Don’t worry if you don’t reach most of them, by experiencing at least one of them, you will learn what strive and satisfaction mean.

Accept the fact that sometimes, help from others is what you need to get better, understand, gain hope and/or learn what you aren’t capable of learning by yourself.

Share through conversation.

Stay on top of things, this minimizes the risk of error. If you end up making a mistake, learn from it and accept that perfection is only a concept not a fact from empirical evidence. 

You will meet people that will suddenly leave your life, just as they came into it. Sometimes, you may suffer because of that, but don’t tell yourself it was a waste of time, instead remind yourself that you learn something from every person, focus on what you learned and be grateful.

Finish this sentence; there is nothing greater than…

Give good advice when you are asked, don’t forget to mention details and your honest opinion along with it, just because you think the person should discover his/her own path. They will choose privately and find the necessities to build it with experience of their own and whatever advice they got.

Every person is an individual, different, so respect equality in the sense of tolerance.

Read, through this you will have somewhat complete and better facts.

Help whenever you are fully capable of doing it, don’t act like a hero, this could worsen whoever needs helping. 

Don’t criticize because you don’t have it or can’t do it, admire and share whatever they don’t have or can’t do, this way you will both learn humility and wonder. 

When you die, you don’t take anything with you, but you do leave memories behind.

Lay on your back with a friend and stare into the night, see how the conversation pours.

Don’t save your energy for later, do what you have to do the moment you can do it.

Don’t lose hope because a problem is put in front of you, here is when your capabilities will help you reach the solution.

Cherish people not things.

Don’t become frustrated because you don’t know everything, there has never been a person that fits the complete definition of wise. Instead, be grateful that you are driven because ignorance is not an option for you.

You can write a life list, but “actions speak louder than words”.