A rise in HIV infection rates in South Africa's Western Cape Province could be linked to the growing popularity of a relatively new but highly addictive and easily accessible drug, some analysts are beginning to suspect.

"AIDS is still far from being accepted in Côte d'Ivoire," says Kofi. "People have very backward ideas and believe it is something dirty. Many still remember the first awareness campaigns of prevention posters featuring extremely skinny people". "It was a mistake to consider children separately from their parents, the best way to help children is to involve them and find an approach that's beneficial to the entire family."

The number of cholera deaths continues to rise in Guinea this year as state radio reported a new flood of cases in the Forest Region of the southeast. State radio on Wednesday reported the deaths of 16 persons in the Kissidougou prefecture, 500 km southwest of the capital Conakry, and local clinics have registered a further 173 cases of the water borne disease.

The World Health Organization has sent a consignment of drugs, re-hydration salts and disinfectant to help fight a cholera outbreak that has claimed close to 1,900 lives in Angola. An estimated 46,758 people have been infected since February when the epidemic began in the capital, Luanda. It has since spread to 14 of the country's 18 provinces.

South Africa's new health legislation, the National Health Act 61 of 2003, designed to tackle the public health crisis and the HIV/Aids pandemic, conflicts with binding commitments made by the former apartheid regime under the World Trade Organization's General Agreement on Trade in Services (GATS). This illegitimate trade treaty makes meeting the health needs of most South Africans far more difficult, says a new report released by the South African Municipal Workers Union and the Municipal Services Project.

South Africa’s new flagship health legislation, designed to combat a daunting and urgent public health crisis, conflicts with legally binding commitments the former apartheid regime negotiated under the World Trade Organization’s (WTO’s) General Agreement on Trade in Services (GATS).

This trade treaty conflict threatens to undermine the much-needed legislation and, if left unresolved, would make meeting the health needs of the majority of the population far more difficult.South Africa’s dilemma should serve as a world-wide warning that health policy-makers, governments and citizens need to be far more attentive to negotiations that are now underway in Geneva to expand the reach of the GATS.

South Africa’s National Health Act (NHA) aims to remedy past injustices by creating a more uniform and egalitarian national health care system. It is the current government’s chief legislative response to continuing health care challenges in a country where the social and economic costs of the worsening HIV/AIDS pandemic have greatly exacerbated the structural problems inherited from the apartheid era. Scarce health resources are still disproportionately directed to rich and urban citizens. South Africa’s National Health Act (NHA) aims to remedy past injustices by creating a more uniform and egalitarian national health care system.

The General Agreement on Trade in Services (GATS) is no ordinary trade treaty. It is exceptionally complex and broad in scope. It aims to expand international commerce by restricting government measures that impede the ability of foreign companies and investors to maximise profit by supplying services, including health services. Once a national government agrees to cover a particular service sector under the GATS, this “specific commitment” binds all future governments, under threat of punitive trade sanctions.

This is the difficult situation in which the current South African government finds itself. In 1994, South Africa made GATS commitments covering a huge swath of the country’s health services. Almost all human health services delivered outside of hospitals by doctors, dentists, nurses, midwives and other health professions are directly and explicitly covered. However, these commitments are not classified under health but under the Professional Services sub-sector of Business Services. This bizarre classification system, together with the commitments having been made by the apartheid regime some 10 years before the drafting of the National Health Act probably explains why both South African trade and health officials denied for so long that the country’s health services are covered under the GATS.

The conflicts between South Africa’s health legislation and the international services treaty are substantial. In general, public planning policies that allocate health resources more equitably between urban and rural areas, between rich and poor people, and between public and private sectors conflict with the GATS prohibitions against limiting the numbers or activities of private sector service providers.

In particular, the NHA’s “certificate of need” system conflicts with the GATS Market Access rule (Article XVI). This system is the legislation’s primary policy instrument, requiring all health establishments to acquire a “certificate of need” in order to operate. The legislation gives the health minister the authority to grant or refuse certificates based on community needs, and to set conditions on certificates, such as requiring health establishments to service poorly-served regions or populations, or to train community health care professionals.

These basic measures, which are moderate and typical by world health policy standards, conflict with GATS Article XVI:2. This GATS provision explicitly prohibits the application of such “economic needs tests” to the approval of new facilities or the expansion of existing health establishments. The GATS also threatens the health legislation and related policies in other ways. The application of the GATS National Treatment rules (Article XVII) to all health sectors and sub-sectors listed in the South African schedule of commitments creates a host of regulatory issues and problems. Community-based control and decision-making, local training and technology transfer options, directed health care subsidies and incentives, and black economic empowerment policies are all at risk.

GATS negotiations are currently underway on Domestic Regulation (GATS Article VI:4). If these negotiations result, as planned, in new restrictions on non-discriminatory government regulation, the apartheid-era commitments covering health services would create further problematic conflicts with the National Health Act.

The approaches embodied in South Africa’s current health policies and its GATS commitments are incompatible. The government can choose either to conform to legally binding, but illegitimate, treaty commitments made by apartheid-era negotiators, or it can implement the NHA and related policies to try to achieve a more equitable health care system. The existing inequities within the health care system are in need of urgent reform. There is also an overarching responsibility, enshrined in South Africa’s now democratic constitution, for the state to protect health and other basic human rights. Accordingly, the morally and constitutionally valid way for the government to resolve these conflicts is to bring the country’s GATS commitments into conformity with South Africa’s health policy imperatives.

Failure to resolve this trade treaty issue promptly could, over time, divert effort and scarce resources from the central task of health care reform. It would enable foreign for-profit health service corporations, through their home governments, to launch GATS challenges that could thwart the implementation of the National Health Act and related policies.

There are several possible options for dealing with the GATS problem. One option is for South Africa to implement the National Health Act as planned, and deal with any potential GATS issues as they arise. This “wait-and-see” approach is, however, unlikely to be effective over time. Due to the stark inconsistency between the NHA and the GATS, disputes are to be expected. Losing such a case would expose South Africa to the threat of trade sanctions targeted against the country’s key exports.

Another option is for South Africa to withdraw its GATS commitments covering health services. This approach would resolve the immediate GATS threat to the NHA. A drawback, however, is that South Africa would be required to negotiate increased GATS coverage in other sectors to compensate affected WTO member governments for their service suppliers’ lost “market access” in health services.

A third, more ambitious approach would begin with the withdrawal of the GATS commitments. This would be accompanied by the South African government leading or participating in collective action by like-minded governments and citizen movements to tackle the threats that the GATS poses to progressive health policies. This would be consistent with the GATS and similar treaties being fundamentally changed to address the basic incompatibility between their commercializing imperatives and policies to realise health as a human right for all. The GATS is corrosive to a variety of public service systems and to regulation in the public interest.

Instead of the current negotiations to broaden and deepen GATS coverage, there needs to be a thorough assessment of the treaty’s defects from a health policy and public interest perspective, and joint international action for concrete changes to remedy its structural flaws. Bringing South Africa’s GATS obligations into line with its new national health legislation should be viewed as a necessary first step towards the vital goal of creating more democratic international governance frameworks for human and social development. Instead of the current negotiations to broaden and deepen GATS coverage, there needs to be an assessment of the treaty’s defects and joint international action to create more democratic international governance frameworks.

South Africa’s predicament is a cautionary tale. All the evidence suggests that the drafters of the Health Act either did not know about the country’s health commitments under GATS or had forgotten about them. The officials who knew about GATS resided in South Africa’s Department of Trade & Industry. But they knew nothing about the Health Act until it had already passed through parliament and were alerted to the problem by the South African Municipal Workers' Union (Samwu). These same trade officials now publicly accuse Samwu of being “unpatriotic” in bringing public attention to the conflict between GATS and the National Health Act.

* This is a summary of a report "The GATS and South Africa's National Health Act: A Cautionary Tale" based on a research project commissioned by the South African Municipal Workers Union and the Municipal Services Project, published in June 2006. Contact Jeff Rudin of Samwu ([email protected]) for more information or a copy of the report.

* Please send comments to or comment online at www.pambazuka.org

Tajudeed Abdul Raheem asks who the real terrorists are in Mogadishu: Those who have held the people to ransom for two decades or those who have chased them away?

When a people have suffered for a long time under a dictatorship the tendency is to declare that nothing could be worse than what they were experiencing. Lived experience does teach a different lesson. No matter how bad the situation is it could always be worse. But the opposite is also true. No matter how good it is it can always be better.

Who would have thought that the jubilations at the exit of Somalia's long term dictator, Mohammed Siad Barre, in 1991 would quickly turn into a prolonged nightmare for his compatriots who have not known peace or even enjoyed the protection of a legitimate government since then. Siad Barre lies reburied in Mogadishu after his body was returned from Nigeria where his life ended peacefully after being given a 'safe haven' by the Nigerian government. The country he led with 'iron fists' and 'velvet tongue' for more than two decades is wasted and wasting between different pretenders to Barre's crown, who are all warlords well-equipped to destroy states but possess no skills for building a nation.

Somalia also tragically epitomises a number of contradictions for those of us who proclaim 'African solutions to African problems' and Pan Africanism, rightly eschewing external meddling by imperialist powers in African affairs but sometimes ambiguous about the sub imperialist meddling of fellow African states. One, is our loyalty to a state or to peoples? The state of Somalia has collapsed and probably may never be one state again, but somehow the international system has kept it existing because it remains the unit of discussion whether at the AU or UN. Somali peoples, like all victims of colonialism, are divided among many countries: Kenya, Ethiopia and Djibouti in addition to Somalia itself. In Somalia itself the south is claiming to be Somaliland while Puntland is also claiming to be independent of both Somalia and Djibouti. Though the Somali state has collapsed the Somali people continue to exist.

Two, it is not about fixing the Somali state but actually looking at it beyond the colonial borders and finding a regional solution to it. It points to federal and con-federal arrangements of the East and Horn of African states. But this logical political conclusion challenges the basis of all our states. That is why even the laudable work of the IGAD states backed by the AU and supported by genuine friends of Africa internationally is falling short of achieving peace and stability in Somalia and the region. They are looking at it as a Somali problem (and a hard dose of prejudice of them being 'difficult' Muslims prone to clan violence) instead of being a Pan African problem.

If we respond to it boldly it will not be limited to Somalis. It will address the historical problems of being part of but not belonging, of many arbitrarily nationalities across this continent: Banyarwanda, Banyamulenge, Bafumbira, Ewes, Ja luos, Ba samia, Hausa, Yoruba, Tswana, Basuto, Tigre, to mention just a few. But it will also change the map of Africa. It is the lack of political will to face the inevitable that is making our leaders engage in half-measures that often give disproportionate influence to war lords at our negotiating tables. IGAD states did a great job in patiently facilitating and negotiating for peace in Somalia, leading to the formation of the transitional government two years ago. However the reality now is that that government has been overtaken by major political developments. To insist on it and deal with it as though it is a normal government risks making not just the TFG but also the IGADD and the AU irrelevant in resolving the Somali issue.

There are a number of reasons for this. First, though the TFG is the result of tortuous and complex negotiations that seemed all-inclusive, the warlords had more power and influence in the shape of it. Their crimes, many of them qualifying as 'crimes against humanity' were rewarded with impunity.

Two, precisely because they were rewarded instead of them changing their old ways they continued business as usual in Mogadishu, trying to gain advantage over each other. That's why the TFG has metamorphosed from a refugee government based in Kenya into an internally displaced government first hosted by the warlord, Mohammed Dheere, in Jowhar, but now relocated to Baidoa, and why the interim president, Abdulahi Yusuf, is being hosted by yet another war lord.

Three, while the TFG enjoys the diplomatic and political recognition of the AU and internationally, it does not seem to enjoy popular legitimacy and it is unable to impose its legal authority at home. Can the world force Somalis to accept a government that is ineffective and doomed to remain ineffectual? This is the context which some of the neighbours of Somalia and global geo-political power mongers are exploiting. While officially publicly offering support for the TFG their actions have helped to undermine and erode its fragile legitimacy. Chief among these are the US and Ethiopia.

The militias in Mogadishu have used both countries' unprincipled alliances in Somali politics and their obsession with 'Islamic fundamentalism' to gain support. Meanwhile Somalis fed up with the militias and wanting a 'law and order' environment and a guarantee of personal and group security for their lives and property turn to their culture, traditional structures and religion. The Union of Islamic Courts led by an ordinary teacher Sheikh Sharif Sheik Ahmed, is the umbrella under which ordinary Somalis have united to get rid of militias and warlords backed by various foreign interests. The ease with which they have moved from Mogadishu to other areas of the country should caution us from joining the sponsors of defeated and fleeing warlords who call them yet another 'Muslim fundamentalist' group. They are giving indications of being a popular movement . As yet they are unclear of their purpose as a government and probably ill-equipped to govern a modern state but they are able to bring security and peace based on notions of Islamic rule of Law and social justice. They have rendered the TFG a dead horse. For how long are we going to be insisting that Somalis ride this dead horse?

What is now happening in Mogadishu, Beledweyne and other cities is quite similar to what has happened in Somaliland, where a coalition of similar Islamist forces (up to now not recognised by any other state in the world) have managed to maintain peace and security based on a mixture of cultural order and conservative Islamic values. Neighbours and other foreigners should not be allowed to hide their sub imperialist and imperialist interests behind support for the TFG . There are reports (denied by Addis Ababa) that Ethiopia has sent troops to Baidoa and is arming the TFG, while the Americans have also denied supporting the defeated and fleeing warlords. Two of them, Bashir Rage and Sudi Yallaow, were allegedly rescued by American marines off the coast of Somalia while they were fleeing. Another war lord, Mohamed Abdi Qanyare is reported to have fled to El-Dheere while his name sake Mohammed Dheere is reported to have fled to Addis Ababa.

Meanwhile the other warlords in Mogadishu, Hussein Aideed and Ali Ato, have willingly surrended themselves to the Union of Islamic courts, hoping to join 'the storm' thy could not stop. Ato reportedly compared the highly successful routing of all the warlords by the Islamists to being 'hit by hurricane'.

As the AU meets in Banjul, Gambia next week our leaders have to reflect very seriously on the admittedly difficult challenges posed by the latest twist in the tragedy of Somalia. The IGADD states and the AU need to be sufficiently flexible and nuanced in handling this new situation. It is possible that the Union of Islamic courts may cooperate with the TFG but as long as the TFG does not insist on formal legalism. The TFG could also use the Union to build a popular legitimacy if they are seen to be cooperating. So far the Union has not been imposing leaders - rather they ask all the residents to choose their leaders to work with the new order. In some cases, significantly in Mogadishu itself, where people have opted for the leader put there by the TFG, the Union has not refused to honor that choice, hence the mayor of Mogadishu remains the same.

There needs to be clarity as to who will have sanctions imposed on them. Is it those who are now restoring order or the fleeing former warlords? If the AU encourages Ethiopia, the USA and other meddlers to continue to arm the TFG in the name of being the legitimate government it will be fueling more death and destruction and giving the fleeing warlords a new lease of life. For decades, the Somali state has been formed and reformed and deformed around the interests of various militarised local elites and various external geo-political interests. Now the voice of the people of Somalia seem to be coming out loud and clear. So the fundamental question is: Are you for the state or the people? Who are the terrorists in Somalia? Those who have held the people to ransom for two decades or those who have chased them away?

* Dr Tajudeen Abdul-Raheem is General-Secretary of the Pan African Movement, Kampala (Uganda) and Co-Director of Justice Africa

* Please send comments to or comment online at www.pambazuka.org

This book of 90 critical and thought-provoking essays, selected from over 150 written between 1990 and 2005 in three different newspapers, captures the richness of Shivji’s contributions as a public intellectual. It deals with the period when Tanzania under external pressures from donors and financial institutions was forced down the road of neo-liberalism.

The World Health Assembly closed on Saturday (27 May) after adopting several decisions on a range of health issues. The most important of these was a resolution establishing a working group to produce a global strategy and action plan on intellectual property, health research and public health, writes Martin Khor on the website of Third World Network. The WHA also passed a resolution giving the WHO secretariat the mandate to assist governments to take on board health concerns in trade policies and trade agreements.

The global fight against the practice of torture received a major boost on 23rd May, when Honduras and Bolivia simultaneously ratified the Optional Protocol to the UN Convention against Torture (OPCAT). This means that OPCAT will formally enter into force this coming Thursday, 22nd June since it now has the twenty ratifications necessary for it to come into effect. This news was greeted with satisfaction by the Director of the Commonwealth Human Rights Initiative (CHRI), Ms. Maja Daruwala. "The practice of torture is shockingly widespread all over the Commonwealth, and OCPAT can be a major weapon in fighting this scourge," she stated.
* See for more details on the Protocol.

Tom Gitaa, Kenyan immigrant to the U.S. and founder of Mshale, the African community newspaper based in Minneapolis, talks to Shailja Patel about the ethos behind the newspaper and its impact on the immigrant community there.

It's been a hectic weekend so far for Tom Gitaa, and it's not even Saturday afternoon yet. "I work 24 hours," says the publisher of Mshale, the African community newspaper based in Minneapolis, Minnesota. Begun in 1994, as a 2-page photocopied newsletter, Mshale is now a free monthly paper, covering news and issues relevant to the pan-African immigrant community. 15,000 copies a month are distributed through the Northeastern US states of Minnesota, Wisconsin, Iowa, North Dakota, and South Dakota.

Gitaa is also the host and presenter of Talking Drum, a current affairs talk show on ABN- America (African Broadcasting Network). ABN airs on Channel 749 Dish Network. He has just returned from a trip to Gambia, to set up local production operations for ABN's coverage of the upcoming AU summit. On his schedule this morning was an interview with the visiting Moroccan ambassador to the US. At midnight last night, Gitaa learned that a pipe had burst at ABN's studio, requiring a flurry of calls to relocate the meeting to the presidential suite at a downtown hotel. After this interview with me, it's back to Mshale's offices to work on the paper for the rest of the day, before heading out to cover a community event this evening. All in a day's work for Gitaa, who says that what drives him is: "the satisfaction of finishing something and seeing that others benefit from it."

Gitaa was born and raised in Mombasa, Kenya. He arrived in the US in 1990 to study business and marketing in college. His career in publishing began when he and two fellow-students, Peter Kegode and Edward Kariuki, noticed the dearth of news from the continent available to Africans in America. This was before the internet media revolution. They began to compile a weekly newsletter which they distributed to other Africans in the local community.

"In 1994, it was a 2-page printed compilation, mailed out to 30 subscribers at $8 / month. After 6 months, we had 80 subscribers at $10 / month, and the newsletter had grown to 4 - 6 pages. 1997 was the turning point. That was when the Kenya Nation newspaper came online. So people no longer needed Mshale to get their news. We switched our content to analysis instead, but didn't fly. Subscriptions were flat for 6 months.

"Then we noticed that the greatest response we got was to local news about the African community here, which no other media was reporting. Any coverage of Africa or Africans in American newspapers presented us as exotic and bizarre. I realized I could do a better job of explaining who we are in this place. Why not do a profile of this taxi driver from Ghana struggling to feed his family? Or that Somali woman who has opened a boutique?

"As a business major, looking at the demographic, I could see this was a growing market. In 1990, there were 20,000 African immigrants in Minnesota. In 2006, there were 80,000, according to state census. My personal estimate is that the number is closer to 100,000. Apparently, Minnesota has the largest population of Somalis outside Somalia - it used to be Toronto, but now Minnesota has taken over.

"In November 2001, we put out our first free edition in newsprint."

What is Gitaa's take on the state of media in Africa?

"Quality is rising. Democratization needs supporting instruments - free press, free speech, free airwaves. There have been complaints that freeing the airwaves from state monopolies has led to a bombardment of mediocre pop culture products from the west. But for me, the key question is - are the airwaves free? Can we say what we need to say? Then we will grow and develop towards it."

What media models did he look to in Mshale's development?

"African American community media, and the alternative press. Their experience is somewhat different from ours, but the business model - advertiser-driven free newspapers - is effective. The subscriber-driven model we began with is a tough model one. A large portion of our readership are student-workers, meaning Africans working to put themselves through college. Or newly arrived immigrants. They move frequently, and they are hard to keep track of for mailing out copies and renewing subscriptions."

It is only in the last year that Gitaa has been able to quit his day-job in marketing, and focus full-time on Mshale. He still wears multiple hats, as publisher, editor, marketing director, reporter. Inevitably, there are conflicts of interest between the different roles.

"My goal as we grow is to separate the editorial role and the publishing role as our funding allows. A lot of advertisers don't understand why it's important to have separation between editorial content and ad content.

"For example, we may have as a major advertiser the owners / managers of a large apartment complex with a lot of African immigrant tenants. Our readership make up one of their key markets. If we receive reports that African tenants are being mistreated, we dispatch a reporter to investigate. S/he will speak to the tenants, speak to the complex managers, draw her conclusions and write a report. We run the report. The next thing we know, the media buyer for this company is on the phone to me:

"Mr. Gitaa, we don't like the way you put things in the article that you ran on the complex. It showed our client in a negative light."

"Next edition - no ad from this client. And if they are one of our two Fortune 500 advertisers, then that may prompt the second Fortune 500 company to take its ad elsewhere.

"Our business model is ad-driven. Ads are our revenue.

"That's where you say: "You know what? Keep your money." As publisher, I am accountable to the African immigrant community. My focus is whatever impacts that community. We will not do anything that will not serve that community well.

"This is what makes readers respect you - when they can see you lost money, but you did not let it influence the content of the paper. It is a difficult choice - you risk going out of business. It's the perpetual dilemma of the publisher.”

Has Mshale also come up against divisions and internal conflicts within the African community?

"Yes, several times. There are deep internal rifts within the immigrant community. When we reported on a few Somali women who are successful entrepreneurs in Minneapolis, it provoked deep animosity from some senior leaders within the community. We were just telling the success story of our people, but their reaction was very derogatory."

Given these rifts, and the diversity of African immigrants - across socio-economic groups, class, nationality, origin - can one even speak usefully of a pan-African immigrant community with common interests?

"You are correct about the diversity. But from my years of building Mshale, I see 3 uniting interests across these differences.

"First is the issue of immigration. All immigrants from Africa, whatever their socio-economic status, wherever they come from, are interested in creating a legislative climate that supports their rights to build a life here, and allows the possibility to bring their families here. They are all equally affected by anti-immigrant sentiment and the conservative ideology of closed borders.

"The most-read page of Mshale is the immigration page. It is written by the legal counsel of Blackwell Igbanugo - the largest black-operated law firm in the US. The leading partner, Eugene Igbanugo, was one of the first advertisers in the initial Mshale newsletter, and since then, there has not been a single issue of Mshale that has not carried their ad.

"The second uniting interest is that of self-development. We all arrive here with a common work ethic, the drive to take advantage of opportunities to realize our dreams. We are all aspiring. But we don't shut our eyes to the need for social support systems and networks, the understanding that people need a hand up to get on their feet.

"I believe in the capitalist system. I come from a family of business people. I can say that it works. But I don't understand, for example, the public outcry over the welfare system from the Republicans. If you look at the big picture, the US welfare system takes less than 1% of the federal budget!

"We are a pan-African newspaper. I take that seriously. I get frustrated with other community papers / media that present themselves as "Pan African", yet 80% of the content is skewed towards a particular region. If you call yourself Pan African, then represent every region of Africa. At Mshale, we try to be a model of broad coverage across every region and segment of the African immigrant community."

Does he see community media such as Mshale having an impact on the coverage of Africa and Africans in mainstream American media?

"Many of our readers are journalists and editors from mainstream media outlets. They use Mshale as the gauge, the barometer of what's going on in the African community here. They read it to stay on top of that niche.

"Our website is an archive of information, and is often used as a resource for research about the African immigrant community. We also field calls frequently from those seeking knowledge on particular countries, regions or communities, for business or study. We have become a reference source on Africa."

Looking back over the 12 years from the inception of Mshale to it's current burgeoning success, what does Gitaa see as the key to successful community publishing?

"Relationship building. In the beginning, when we were just 3 people with no track record, it was very hard to establish credibility, to get interviews. No one knew who we were. But with persistence, and steady presence, they get to know you and to respect what you are doing. We now have very strong relationships with the International Leadership Institute (a leading African American organization that brings notable Africans to the US) and the Minneapolis International Centre (which hosts tours of visiting Heads of State and world figures). They call us whenever something relevant to Mshale is on their calendar.

"All the local immigrant community associations know they can count on us. If they let us know what they are doing, we will give them coverage.

"Mshale tells the African immigrant community that whatever direction we go in in this country, we don't need to forget how we look at ourselves. We need to make sure people know who we are."

www.abnamerica.com

* Shailja Patel is an Asian African poet and theater artist. Visit her at www.shailja.com

* Please send comments to [email protected] or comment online at www.pambazuka.org

More safe blood is needed in Africa, said the World Health Organisation (WHO) on World Blood Day on Wednesday 14 June. "The need to collect enough blood and to make it available for patients is more acute in developing countries, and particularly in Africa," said Dr Luis Gomes Sambo.

HIV/AIDS programmes in sub-Saharan Africa cannot be implemented by doctors and nurses alone if they are to expand to meet the treatment needs of citizens, according to Dr Mark Dybul, acting US Global AIDS Co-ordinator.

Health officials have confirmed a surge in polio infections in northern Nigeria that threatens to undermine global efforts to eradicate the crippling disease. Edugie Abebe, head of Nigeria’s National Programme on Immunisation (NPI) announced that 467 new polio cases have been recorded this year, more than double the number of cases recorded in the whole of 2005.

Oxfam last Friday released a report criticizing the Group of Eight industrialized nations for not providing enough aid to international development programs -including programs to fight HIV/AIDS - and for pulling money from aid budgets to cancel debt owed by developing countries, the AP/Yahoo! News reports. The report, released Friday ahead of this year's G8 summit in St. Petersburg, Russia, says three global initiatives - the Global Fund To Fight AIDS, Tuberculosis and Malaria, the Education Fast Track Initiative and the new UN Central Emergencies Response Fund - are "shockingly underfunded."

Heads of state and governments from more than 40 African nations have agreed to lift all cross-border taxes and tariffs on fertilizer, designating mineral and organic fertilizer as a "strategic commodity." They also agreed to establish an African fertilizer financing mechanism within the African Development Bank to significantly increase the availability and access to fertilizer on the continent.

Authorities on Tanzania's semiautonomous island of Zanzibar have intensified efforts to control the importation of chicken in a bid to check the threat of bird flu on the island. The deadly H5N1 strain of avian flu has already been reported in several African countries. The poultry industry in Asia and a number of European countries has been ravaged by the disease, which has also claimed dozens of human lives.

Reduce malaria, worms and bilharzia, make border posts more efficient – and HIV rates will drop, argues a US expert. Malnutrition, malaria and bilharzia – coupled with weak governments – are some of the key factors driving the HIV/AIDS epidemic in Africa, according to US academic Professor Eileen Stillwaggon. Taking a swipe at those who try to blame sexual behaviour for the rampant HIV epidemic in southern Africa, she says that they are caught up in “exotic notions” about Africans.

A new policy of free medical care for Burundian mothers and children was intended to improve their lives; instead it has crippled the nation's health system. Public hospitals in Burundi have recorded double, sometimes triple, the number of patients since a presidential directive for free paediatric and maternal health services was implemented on May 1.

Public clinics and hospitals in Harare, are running out of desperately needed drugs to treat tuberculosis as a worsening hard-currency shortage hits state health facilities, it was reported on June 8. Overcrowding and poor hygiene have seen increasing cases of TB surfacing in Harare. The high incidence of HIV/Aids has also led to the spread of the highly infectious disease.

Last Friday evening, the United Nations adopted a Political Declaration of Commitment on HIV/Aids following a meeting in New York to thrash out a response to the pandemic. While welcomed in some quarters, the declaration has also faced criticism from an African civil society grouping, who described it as an “utter disappointment” and declared a Week of Action - from June 13 to 17 - to mobilize support for previous commitments made by African governments to fighting the pandemic (Please see the HIV/Aids section of Pambazuka News for more details). In the article below, Salma Maoulidi goes beyond showcasing the pandemic in an attempt to “deal with why it is and is allowed to be”.

Tanzania has a national HIV/Aids policy and is in the process of finalizing legislation on HIV/Aids. The expectation is that once the policy and legal framework is set, people living with HIV/Aids and their families will be afforded greater protection. But will a legal framework that solely addresses the public health dimensions of HIV/Aids and not the intimate aspects of personal relationships that maintain the status-quo in power relations between the sexes suffice?

Treating an invisible syndrome

When one reads the alarming statistics explaining the magnitude of HIV/Aids in sub-Saharan Africa one gets an impression that people are dropping down like flies. One would think that as one walks the streets, every other person would be noticeably HIV positive. This, however, is not the case, not because HIV/Aids is not present but because it is rendered invisible - something that makes ongoing efforts to combat HIV/AIDS ineffective, if not difficult.

While HIV/Aids is very much in our midst it remains hidden from many either by choice or by design. It remains hidden by choice because we choose not to see it; or those that are affected by it choose not to divulge their status. It remains hidden by design when those who have it go to extra lengths to conceal their positive status. Also, it remains obscured when the state fails to address the problem at its core, that is confronting the underlying cause contributing to widespread infections rather than its consequence.

I have been following the progression of HIV/Aids since the mid-eighties when the formulation of the first national response against HIV/Aids emerged, but it remained invisible to me until the late nineties. Until then my association with HIV/Aids was based on health statistics and my long association with women’s sexual and reproductive health and rights. Putting a face to someone living with the virus came much later. But when these live testimonies finally emerged they were persistent in underscoring the pervasiveness of the pandemic. From the outset, it became clear to me that each story of a women who had contracted the virus was peculiar and in most cases did not meet the popular myths around HIV/Aids.

There are many dimensions to the problem that is HIV/Aids, something that is not so clear with prevailing responses against the disease. One can only appreciate the complexity involved in combating the pandemic when one reviews the stories of countless women, men and children infected and affected by HIV/Aids. It is also these stories that inform my political stance on the adequacy of existing HIV/Aids approaches in combating the pandemic.

Protecting the unsuspecting

One of the first cases I came across involved a bright girl, full of life and humour. I met her for the first time when she was ten but looked more like a five year old. She was born HIV positive, a fact that led her father to abandon the family. It was left to her mother and elder sibling to love and provide for her amidst great hardship. Although an innocent child, she was not spared the humiliation meted out on PLWHA’s that resulted from prevalent institutional ignorance about HIV/Aids. Her teachers openly discriminated against her, forcing her to wear a red badge to signify her HIV status.

Fortunately, her mother joined an association of PLWHA which provided her and the family with much needed moral and material support. Her sisters, who were not positive, became peer educators and volunteers for an HIV/Aids community based programme. She thus never saw herself as a victim. She accepted her condition and sought to live to the fullest in spite of the fact that she was positive. Her status was only an issue when it made her too sick to play or attend school. She died before her twelfth birthday, unable to realize her many dreams. Her brave attitude gave us a useful advocacy platform to intensify the campaign for the rights of PLWHA.

Progressively, the reality of HIV/Aids came close to home when a close friend of mine lost her baby girl. Although she had suffered bouts of TB it only became clear that she may be infected with the virus after her very sick daughter was diagnosed with the virus. Indeed it is not exceptional that many women get to know about their positive status in this manner since they do not fit the profile of women who are likely to be infected with the virus in the sense that they are not prostitutes or “loose” women but women who are in stable relationships, the majority having the respectable status of being someone’s wife and, therefore, by local social standards, outside the ambit of the risk category associated with immoral behavior.

Consequently, a significant number of HIV positive women I know contracted the virus as unsuspecting victims. They were brought up to believe that it was enough that they were in a happy, healthy and lasting marriage. The husband’s fidelity was immaterial to complete this equation. On the contrary, the overwhelming perception is that a chaste and faithful wife sufficed to protect the family from ill health and ensure a strong progeny. Increasingly women are finding that an institution that was traditionally meant to provide them with security, stability, health and respect is in fact endangering their lives and livelihoods.

Many of these women are torn between confronting their problem and in so doing drawing attention to themselves, a fact that leaves them vulnerable to public scorn and stigmatization. Importantly, it has the potential to ostracize them from traditional systems of support, especially after their spouse rejects them upon divulging their status. Indeed it is the dilemmas and contradictions women face as the weaker sex that puts them at risk of contracting the virus. Certainly, it is the denial of women’s agency in matters of sexual and reproductive nature that informs women’s social and economic predicament, a situation intensified by the HIV/Aids pandemic.

Are we fighting a disease or a curse?

The contradictory nature of the disease vis a vis women’s wellbeing is most evident in the story of my namesake, now deceased, who I came to know by virtue of my work with Muslim women. She was an only child, begotten late in life. Her elderly mother was anxious about her welfare after she passed on, such that when a widower proposed marriage she hastily agreed, believing that she was marrying her child to a responsible man. She did not know how her future son-in-law lost his wife nor did he oblige the information. It seems that he had two main concerns - either to draw upon the youth and vitality of his young bride to will himself to good health or to have a healthy person to care for him as his health deteriorated. In either case it was not the welfare of his new wife that was paramount to the fatal union nor did he take any measures to minimize the risk of infection to his young wife.

Next my cousin fell ill to recurrent bouts of TB. In his quest to prove that he did not have something more serious, he repeatedly neglected to complete the prescribed dose for treating the disease, creating resistance against TB. His mother and siblings never accepted that he may have contracted HIV, though they knew he was a womanizer. Instead they were more willing to forgive his philandering but content to blame his wife and her mother for bewitching him. In vain my aunt tried to break the marriage as her son’s condition deteriorated, perhaps to minimize the likelihood of her laying any claims to the matrimonial property, but failed. To our dismay my aunt unceremoniously chased the widow out of the house immediately upon completing her iddat (the mourning period) in spite of the fact that she had two young sons.

Then the young woman who helps us around the house was afflicted by a double HIV/Aids tragedy: her brother in law died after a long illness that was explained as diabetes coupled with witchcraft. During her time off she visited her sister and took care of him. There is no knowing what risk she exposed herself to as she only confirmed that he may have died of Aids after her sister succumbed and died soon after. This tragedy ended the working life of this young woman as her mother went into shock, forcing her to take a leave of absence to nurse her until she died. To save her from a predicament like her sister’s, her uncle and brothers planned to marry her off to a man who had been divorced thrice.

While a number of these women were ignorant about their status, a number were in denial not because of arrogance but because they feared the repercussions their status might have. My friend took some time to accept her HIV positive status. A lot of anger was exhibited against her husband’s long love interest and while she came from a religious family she readily invoked witchcraft to explain her errant husband’s behaviour. Perhaps it was more tolerable to accept that her husband was not acting in selfish disregard of her feelings and health were it not for an evil third hand or influence.

My most recent house help must have known for sometime she had the virus but instead of focusing on her condition actively sought out other women suspected to be infected as if in an attempt to deflect attention from her own status. Otherwise she hid her ill health well, substituting it with other debilitating diseases like malaria or typhoid. But when her ten-year old daughter died, she lost her will to live and succumbed almost two months later. The fate of her husband is unknown since he is adamant his daughter was a victim of someone’s bad spell, a view his wife never sought to correct lest she became suspect and was thrown out in the streets.

Interrogating the source of repeated transmissions

The stories serve to underscore certain truths that hardly feature as the key issues in the battle against HIV/Aids. It is more likely for women to admit their HIV status than it is for men. In most cases I have come across, the women were categorical that it was the sexual permissiveness of their partner that put them at risk. In many cases they were unsuspecting victims. In some cases, they suspected infidelity but were helpless to stop it since as opposed to their sexuality being regulated, their husband’s infidelity was given free reign by religious dicta and the legal framework. While society is more preoccupied with the status of the woman during marriage - whether she is a virgin or not; whether she is rebellious or not; whether she is respectable or not - equal consideration is not given to the status of her partner. On the contrary legal and social institutions tend to extol men’s sexual prowess and irresponsibility.

Likewise, while it is common for women who contract the virus to be punished for their condition there is never talk of compensating them for the harm inflicted on them and the ensuring violation of their privacy and property rights. My namesake was disposed of all her property by her in-laws - even her cooking pots - though it was well known that her culinary skills sustained the family during their short married life. She attempted to fight for her rights but died without justice being realized. The sister of my house help was evicted from the house where she lived and nursed her husband and ended up living with a relative before being bundled back to her village to die.

After initial denial my friend is living an open life. She recently lost her husband and is in the middle of a property distribution exercise directed by his family. While the family is keen to expedite her share of inheritance, perhaps in view of her condition, there is no mention of compensating her for the harm her late husband caused her, if not knowingly then by sheer negligence. She dares not bring up the issue lest her in-laws fall short of being generous towards her. It is this attitude of looking at women as creatures to be pitied and helped, instead of full partners in a relationship, that limits their agency and bargaining power in a relationship. Surely, awarding her compensation is not a matter of retribution or her inability to forgive. On the contrary it is her ability to forgive and go on with her life that contributes to her positive and healthy living. But should such chivalry be abused?

The wrong these women have been subjected to goes unrecognized. The contributions they made to families in terms of monetary and non-monetary forms of contributions go unacknowledged. Instead, these women are vilified by relatives and society for their positive status. Their positive status is equal to a death sentence and licenses their dispossession. Their continued existence means they are delaying the process of wealth transfer and if the virus won’t kill them in time, then heart ache and harassment are efficient mechanisms to expedite the sentence!

The unresolved politics of HIV/Aids

Most governments have failed to look at the social impact of HIV/Aids beyond the rhetoric of sharing the burden of looking after those affected by the HIV/Aids scourge. And while the pandemic presents new opportunities for governments to address gender inequalities there is paralysis in taking deliberate action to promote natural and social justice. Certainly the pandemic presents an opportunity to influence reforms in law and attitudes not only towards HIV/Aids but in reforming gender relations. Other than reaffirming state responsibility towards principles of gender equality and justice, it affords states an opportunity to engage in social engineering towards meeting constitutional and civic commitments to its citizens, male and female.

The development sector’s HIV/Aids response fares no better. While it is commonplace to maintain that having HIV/Aids does not amount to having a death sentence, prevailing policies, discourses and practice related to HIV/Aids continuously pass death sentences on those infected by the virus. Though my organization addresses HIV/Aids in the context of reproductive health, I resist working in the field mainly because the overwhelming support to the sector seems to promote welfarism - approaching infected persons as helpless victims thereby subscribing to dominant attitudes that tend to seal the nails on the coffins of those afflicted by the virus. This is an approach to development that we abandoned two decades ago in favour of a more empowering development approach and discourse.

Indeed, whereas we have tried to reclaim the dignity of people who survived gender based physical and sexual violence we are shamelessly victimizing people infected with HIV/Aids. The biggest pastime for people who want to placate their sense of guilt or get a piece of the HIV industry in my country are projects involving HIV/Aids orphans where countless children who are infected or who lost parents to the disease are not allowed to get over their loss and the stigma associated with their loss. The association with HIV/Aids is the brand that sells. Oblivious are we to the message that underlies such projects: Why can’t these children get on with their lives and be assisted by virtue of being orphaned and not because they are orphaned by HIV/Aids?

Also appalling is the wastage of resource poured in by the international community on material purchases and workshops that do very little to actually help communities deal with the HIV pandemic. Indeed, HIV/Aids has become the new development craze diverting much needed income from more sustainable development interventions. Why is overall spending in preventive health and reproductive health falling when they form part of the equation for an effective heath response to the pandemic? I visited Rwanda in 2004 and was appalled to find that each major UN agency and international NGO was into the HIV/Aids sector with very little coordination between them. I found a similar situation in Zanzibar where the bulk of advocacy organizations felt compelled to get into the HIV/Aids sector to secure funding to remain afloat.

I am equally wary of the ongoing politicization of the question of access to anti-retrovirals for PLWHA. Certainly I have no desire to profit pharmaceuticals, who seek to commodify people’s health in the name of a pseudo-cure. I am also hesitant to create dependency on the drugs in the absence of better nutrition and a guarantee that the scientific community is serious in finding a cure or a better drug regiment. The idea is not to create another dependent population, this time not only on food aid or donor aid but on ARVs. The objective should be to empower PLWHA to live healthy and independent lives without fear of incrimination, stigmatization or impoverishment. It should be about giving security and dignity to those infected and affected by HIV/Aids.

Conclusion

Statistics explaining the magnitude of the pandemic are plentiful. It is however not helpful when numbers are considered in a vacuum. I took inspiration from a book a young woman participating in our mentoring program is working on to open dialogue about HIV/Aids. The book is particularly insightful as other than using narratives of women infected and affected by HIV/Aids to expose the human dimension of the pandemic, it does so while charting her personal trajectory with HIV/Aids. She explores myths about the disease; education and prevention strategies; and personal and community responses they invoke. Certainly it is in understanding the interactions that inform individual HIV/Aids experiences that more sustainable prevention options will evolve, options that go beyond showcasing the scourge for what it is but attempt to deal with why it is and is allowed to be.

* Salma Maoulidi is the Executive Director of Sahiba Sisters Foundation, a development network that works with the concerns of Muslim and provincial women. Sahiba’s mission is to build the leadership and organizational skills of women and youth. It has network members in 13 regions of Tanzania.

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