Tag Archives: AIDS and HIV

New study says football is an effective teaching tool for AIDS and HIV prevention programs

Normally I keep the nerdiest research material to myself, but something really exciting and thought-provoking just happened in the world of sports and international development: Coxswain Social Investment has released a new study called “Using Football for HIV/AIDS Prevention in Africa”, and it indicates that football-based AIDS and HIV-prevention programs are highly and uniquely successful.

I’m not surprised by this, but the 55-page report written up all academic-like (the Table of Contents presents no fewer than 15 “findings”) is like a professional reference for the game I love. There’s been a study, there’ve been findings, and they’ve proven what players and fans have known all along: that this people’s game that can be played anywhere in the world with nothing more than a ball is much more than a diversion – it’s a viable delivery model for life-saving messages.

OK, so here’s the thought that provoked me:

3.2 Gender Inequality
The spread of HIV has much to do with gender inequality. HIV is prevalent much more among women than men, and about two thirds of newly-infected young people aged 15-19 years in sub-Saharan Africa are female. Grassroot Soccer stresses the importance of girls benefiting from  prevention efforts by making sure that half its participants are female. In Grassroot Soccer’s Street Skillz Sessions…, football game rules are designed to involve girls as much as possible, for example by counting each goal scored by a girl as two points.
– “Using Football for HIV/AIDS Prevention in Africa”

For some context, Grassroot Soccer is the organization co-founded by former professional soccer player and (TV show) Survivor Ethan Zohn. It’s an organization with a mission I support (“… to provide African youth with the knowledge, skills and support to live HIV-free”) but I’m put off by the practice of handicapping by gender. Ensuring that half of the program participants are female is an obvious and justified mandate, but how does a differential point system play into this? I just don’t get it. [Note: Check out Zak from GRS’ response in the comments. It would appear that this rule in the Street Skillz program is no longer in use, and was never aimed at the AIDS and HIV-prevention aspect of the program. Rather, it was an attempt to facilitate girls’ inclusion by encouraging passing to them.]

I don’t want to take a perfect cause for celebration (yet another example of soccer saving the world) and diminish it by focusing on a single aspect of program delivery. Instead let me present this thought, provoked: Does counting girls’ goals as more than boys’ goals somehow ensure that girls benefit from prevention efforts, whether by encouraging participation in the program or by diminishing gender inequality? If so, how?

For more soccer-related provocation and celebration, download the report here (I found it via Play the Game, which “aims to strengthen the basic ethical values of sport and encourage democracy, transparency and freedom of expression in world sport” – highly recommended reading for the sports development geek.)

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“Playing soccer makes me feel like I am alive.”

Médecins Sans Frontières / Doctors Without Borders (MSF) has organized an alternative 5/side soccer tournament called HALFTIME!, which is designed to highlight the widening HIV/AIDS treatment funding gap that’s becoming evident across Africa.

Can you imagine the massive outcry if someone stopped the World Cup after the semi-finals? Or if the referee just allowed the final match to be played until halftime only? Yet right now the battle against the HIV/AIDS emergency is being stalled before half-time, risking the lives of 9 million people in need of treatment.
– Dr Gilles van Cutsem, MSF project coordinator in Khayelitsha, South Africa, from “HIV patients refuse to be sidelined by international community in unique football tournament,” published on MSF/DWB site.

Allow me to digress here for a moment. Did anyone watch yesterday’s match between Uruguay and Ghana? Because Ghana was the last African country to have a chance to advance, the game took on a significance way larger than the Cup. The press dubbed the Ghanaian team “Ba-Ghana Ba-Ghana”, a reference to the South African national team’s name “Bafana Bafana” (Zulu for “the boys”), and a tidy way of claiming Ghana for all of Africa. In an event steeped in symbolism (and tribalism), Ghana’s performance would “prove” something about Africa to the world.

At the end of 120 gutting minutes Ghana lost in penalty kicks.

I bring this up because I see a connection between the international response to HIV and AIDS in Africa and the goings-on at the Cup (and clearly, given the many alternative events and initiatives I’ve reported on in these pages, football is an effective language to address these issues).

Predictably, the Cup has shone a spotlight on Africa and has ignited some dialogue about non-football issues facing the continent. For example, the Ghana-Uruguay match was “dedicated to the global fight against racism”, and an anti-racism message was read aloud to the crowd by the team captains. Sure, that feels good, but is it meaningful?

What I am getting at is that piece of this story the rests on Africa’s ability (or not) to “prove” something about itself. The continent is beleaguered by AIDS/HIV, yet the international response is spotty, ineffective, and slow. That’s the issue that MSF/DWB’s HALFTIME! is highlighting. Racism is part of it (in the west, testing positive for HIV is no longer an automatic death sentence; why is it acceptable to see so many Africans die of AIDS?), and it’s gratifying to see this issue brought to the Cup, even if the delivery was stilted and tokenistic. But what happens when everybody goes home?

I think that’s the pressure placed on the Ghana team, cast as they were as “Africa’s hope”. There’s the sense that a win for Ghana would have meant a win for Africa, not only on the pitch but on the world stage.

MSF’s recently released report entitled “No time to quit: HIV/AIDS treatment gap widening in Africa” reveals, through analysis of eight sub-Saharan countries, how major international funding institutions such as PEPFAR, the World Bank, UNITAID, and donors to the Global Fund have decided to cap, reduce or withdraw their spending on HIV treatment and life-saving ARV drugs over the past year and a half.  “Only one in three people living with HIV in urgent need of ARVs have access to it –so we are not halfway there yet in treating everyone. The HIV/AIDS emergency is not over and halftime is no time to quit! Millions of people are at risk dying within the next few years if we don’t do more now to keep donors to their promises. They committed to it, publicly and they knew the treatment is life long,” says Dr. Van Cutsem.
– From “HIV patients refuse to be sidelined by international community in unique football tournament

Why is this acceptable? I believe that some of the answer lies in the subtext of how the world sees Africa. Let’s not forget that there are people behind these numbers.

Playing soccer makes me feel like I am alive. Before going on treatment people were actually counting down the days until my death. Now, with treatment, people see me as a person, and not as a corpse.
– Janet Mpalume, a Zimbabwean MSF patient playing in the HALFTIME! tournament, From “HIV patients refuse to be sidelined by international community in unique football tournament

It’s easy to get caught up in the drama of an international tournament like the World Cup, but let’s remember that while we are watching elite athletes create spectacle on the brand new pitches of South Africa, there are real people waging real wars against AIDS and HIV. And that the worth of a continent or a nation or a person has nothing to do with football.

Make a donation to Medecins san Frontiers/Doctors Without Borders here.

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The people’s game

So. Much. Soccer.

I’ve been like Homer Simpson, tongue lolling sloppily while I gorge myself on game after beautiful game. The World Cup comes only once every four years but makes up for its infrequency with an endless deluge of coverage. For 30 full days. Yum.

As if this weren’t enough, this past weekend I competed in the Toronto International Pride Cup (TIPC), the fourth annual soccer tournament presented by Downtown Soccer Toronto. My history with the league and this event goes way back and is enmeshed with my trip to Africa and the start of this blog. Those curious about how these things are connected could start with this post, and those familiar with the story may be interested to hear that I have again been bestowed with (someone else’s) MVP game ball and the instruction to take it to Africa… I love it when the universe is unmistakeable in its intentions for me.

So guess what? There’s another World Cup going in South Africa right now. According to the Sowetan, the Western Cape Anti-Eviction Campaign has launched a 36-team tournament to highlight the plight of the province’s poor (“Poor’s World Cup keeps drugs at bay,” June 21, 2010). Now this is interesting.

The Western Cape Anti-Eviction Campaign “was formed on November 2000 with the aim of fighting evictions, water cut-offs and poor health services, obtaining free electricity, securing decent housing, and opposing police brutality”, and is an umbrella group for over 15 organizations. (Read more on their About page).

Remember waaaay back before the kick off on June 11? There were a few stories in the papers about FIFA’s stranglehold on every element of the Cup games, and one angle that generated a lot of commentary was the ban on all vendors save for its commercial partners.

Regulations imposed by football’s world governing body Fifa on host countries stipulate that no-one but its commercial partners be allowed trade or promote their products in the immediate vicinity of all World Cup sites.
– “South Africa World Cup ‘just for the rich’,” BBC News, May 10, 2010

So Coca-Cola gets an exclusive license and the ice cream vendor loses his business.

More perplexingly, FIFA also banned the distribution of condoms and health information at World Cup stadia (“AIDS groups protests FIFA ban policy,” The Associated Press, June 5, 2010). I wonder what commercial interests this policy is protecting?

There was press. There were protests.  And then June 11 came and we were all deafened by the Cup cannon (yes it’s an obscure G20 reference) which, incidentally, sounds exactly like tens of thousands of vuvuzelas.

Remember: I am a fan. But I think it’s a shame – a missed opportunity – that these voices have been effectively silenced. The ice cream vendor’s still faced with feeding his family, the rate of HIV and AIDS transmission in South Africa is still enormous.

Enter the Poor People’s World Cup. Thirty-six teams from communities across the Western Cape are competing in the tournament which has a grand prize of R5000 (approximately $650 CDN).

[W]hile the poor people in Cape Town and in South Africa as a whole are suffering, the rich are enjoying themselves in the expensive stadiums at the expenses of the poor… All the traders and communities – that were negatively affected by FIFA related urban renewal projects and by the implemented by-laws – were invited to this tournament: a tournament that is FREE and open to everybody.
– “The First Poor People’s World Cup on African Soil,” from the Western Cape Anti-Eviction Campaign site.

The Poor People’s World Cup: yet another example of people using the people’s game to stage a response to a social problem.

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The literal manufacture of vagina dentata

In between all the watching soccer and playing soccer and talking about soccer I’ve neglected writing about soccer. Or maybe, if I’m honest, I’ve been avoiding it a little bit because this post picks up on a difficult topic that we’ve delved into before (most recently here): rape.

On June 21, CNN published an article by Faith Karimi titled, “South African doctor invents female condoms with ‘teeth’ to fight rape“. It’s exactly what it sounds like: South African doctor Sonnet Ehlers has designed, produced, and distributed a latex sleeve (called “Rape-aXe) that is inserted like a tampon.

Jagged rows of teeth-like hooks line its inside and attach on a man’s penis during penetration, Ehlers said. Once it lodges, only a doctor can remove it — a procedure Ehlers hopes will be done with authorities on standby to make an arrest.  “It hurts, he cannot pee and walk when it’s on,” she said. “If he tries to remove it, it will clasp even tighter… however, it doesn’t break the skin, and there’s no danger of fluid exposure.”
– From “South African doctor invents female condoms with ‘teeth’ to fight rape

There is no doubt that rape – and in particular so-called “corrective” rape – is a serious and systemic problem in South Africa. There is little support for the women who are victimized, especially if they are black and from the townships (as they very often are). Officials don’t recognize “corrective” rape as a distinct type of crime, making their response inadequate at best (just as in the west we fought to characterize and categorize gay-bashing as a hate crime, the particular nature of “corrective” rape must be acknowledged if an effective response if to be mounted).

The last time I wrote about this I was making the simple point that even in the press there seems to be a sense of hopelessness and resignation rather than a call to action. With the high-profile rape, torture and murder of Eudy Similane the issue only gained notoriety. Nothing changed.

Now, at last, a response. But what does this say, that the response is the literal manufacture of vagina dentata?

Critics say the female condom is not a long-term solution and makes women vulnerable to more violence from men trapped by the device. It’s also a form of “enslavement,” said Victoria Kajja, a fellow for the Centers for Disease Control and Prevention in the east African country of Uganda. “The fears surrounding the victim, the act of wearing the condom in anticipation of being assaulted all represent enslavement that no woman should be subjected to.”
– From “South African doctor invents female condoms with ‘teeth’ to fight rape

A point well-taken. And what about the reification of the myth of the toothed vagina? How does this affect the discourse around the issue of rape? I am uneasy with the relationship. It muddies and mystifies, when we need thought that’s concrete and clear. Nonetheless, I can’t quite bring myself to condemn the device outright.

“Ehlers is distributing the female condoms in the various South African cities where the World Cup soccer games are taking place,” Karimi reports.

What do you think? Responses welcomed in the comments.

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Good news for a change

With less than two weeks until the beginning of the World Cup, Africa is everywhere. Inspiring soccer stories share space with reports on the continuing challenges in addressing HIV and AIDS, “corrective” rape, and brutal attacks on the bodies and rights of gays and lesbians. All this press is both a welcome platform for a new agenda, and a harsh exposé, casting long shadows on the impending Cup.

Suffering from a bit of burnout, I’ve been quietly waiting for some good news. Yesterday, I got it.

Back in December 2009, Steven Monjeza and Tiwonge Chimbalanga were arrested and charged with “unnatural practices between males and gross public indecency” after they had a traditional engagement ceremony in Blantyre’s Chirimba township in Malawi. After being held separately in prison for nearly six months, the men were found guilty, and then sentenced to 14 years hard labour (the maximum penalty).

Human rights organizations condemned the ruling and sentence, and word spread on the Internet. Public protests were held in New York City and London. The Centre for the Development of People (CEDEP) set up an online petition, as did Raising Malawi, an organization founded by Madonna and Michael Berg. Madonna released a statement on the site challenging the decision, and invited people to sign their name next to hers. Over 30,000 people did.

Yesterday, Malawi President Bingu wa Mutharika pardoned Monjeza and Chimbalanga and ordered their immediate release.

“In all aspects of reasoning, in all aspects of human understanding, these two gay boys were wrong – totally wrong… However, now that they have been sentenced, I as the president of this country have the powers to pronounce on them and therefore, I have decided that with effect from today, they are pardoned and they will be released.”
– President Bingu wa Mutharika, “Malwai pardons jailed couple,” BBC News

It’s a curious statement, lacking in political heft, but I’ll take it.

This is clearly a victory for Monjeza and Chimbalanga, and for LGBT rights. It’s also an important step towards a better model in dealing with HIV and AIDS (for more on how these things are connected read my post, “The saddest circus in the world“).

There’s a lesson about engagement here. Social media makes it easy to gather, publicize, and comment on global issues. In this case, Facebook was an effective catalyst with multimedia capabilities: details of the story were accompanied by links to petitions and calls to action. We should remember to use these new tools. Bravo to everyone who signed petitions, stood at rallies, and shared these stories.

UPDATE:
More detail on the pardon comes from this story from The Malawi Voice. While Monjeza and Chimbalanga have been pardoned and released, they were taken to their separate homes and ordered not to see each other. Should they contravene the order they could be re-arrested.

“It doesn’t mean that now they are free people, they can keep doing whatever you keep doing…”
– Patricia Kaliati, Malawi’s Minister of Gender and Children, “Gays pardoned but no change to law,” Malawi Voice

Looks like there’s a lot more work to be done in this campaign. It was an important step to release the men, but by stopping short of changing the discriminatory law, the Malawi government has allowed an exception to the rule rather than created a policy change. I suggest that we all (this means you, Madonna) keep lobbying. Sparing their lives was a first step; now spare their love.

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Great news from the Eastern Cape: “Let Us Protect Our Future!” a go!

All over the world, the bureaucratic machine moves slowly. Organizations lumber towards results, interrupted by fiscal years and approval processes. Sometimes brilliant ideas wither and expire before before they’ve had a chance at the table.

In Africa, action sometimes masquerades as idleness. Initiative must take an indirect path. It’s anti-intuitive to the western visitor, and can test our patience. This is no place for frenzied activity, for make-work. Results come more easily to those who understand that the companionable conversation is part of negotiation, not a distraction.

So imagine my surprise to hear that in the meager five months since I left the Eastern Cape, Craig has succeeded where many have given up in frustration. This story picks up where my visit to the Duncan Village Day Hospital left off, way back in October ’09. Here’s what I remember most: Nomalizo’s confident, friendly, energetic face. She was the peer educator who handled the PMTCT workshop in the hospital’s crowded corridor, giving her presentation in both isiXhosa and English. Word was that project funding was set to expire in December ’09 so Craig was there to see if he could employ the peer presenters through his department.

I kept up with the status of the proposal by monitoring Craig’s uniformly exhausted-sounding status updates. Then, recently, this: “Craig Carty just got the email stating that the contract with the hospital network has been signed!!! Prevention education for South Africa’s most at-risk kids a go!!!” In this case (and only in this case), I can excuse the flagrant abuse of exclamation points. This is really big news.

In Craig’s own words (detailed, and very much worth the read):

Adolescent-centered health care is missing from provincial, government-run hospitals. Kids between 10-19 are lumped in with adults, thus many of them become “lost to follow-up” or return to clinics with “adult” problems.  We know that the highest rate of HIV in this country is diagnosed in 20-25 year olds, therefore it is assumed that most contract the illness in their teens. Often they present at hospitals with advanced stages of AIDS as indicated by opportunistic infections which only arise in patients with seriously-damaged immune systems.  If you couple the problems of overburdened ARV clinics with consistent issues of funding, kids presenting with AIDS are kids without a fighting chance at survival.  That’s the reality.  Plus, South Africa just stepped up their treatment standards to match those of the rest of the world in December of 2009.

We created an adolescent-centered education program based upon years of research and data collection from area amaXhosa communities. It is called “Let Us Protect Our Future!” and is co-authored by Drs. John and Loretta Jemmott and Ms. Lynette Gueits.  Initially, it was designed for dissemination within the Department of Educaton as a tool to augment the existing life skills programs.  For logistical reasons, this fell through.  Working with the provincial government, particularly with certain departments, can be daunting (think meetings to discuss meetings to discuss meetings to discuss funding to discuss “how much we’ll get out of this,” etc.).

Shortly after my arrival in South Africa, I was approached by a very passionate physician working within the hospitals of the Eastern Cape. She proposed looking at the manner by which we could disseminate our prevention education program within hospitals, drawing from the patient populations in abortion clinics, maternity wards, HIV care clinics, casualty care (abused kids), pediatrics and chronic care (diabetics, etc.). So we did.

We sent the curriculum to the adolescent division of the CDC for analysis. The feedback was great.  We met with the CEO of local hospitals (Frere and Cecilia Makiwane) as well as the Chief of Clinical Governance.  We developed a 20-page Memorandum of Understanding (ugh) so that we could ultimately “gift” our work unto the health department over the course of about 12 months.  They agreed to integrate the campaign into their 5-year fiscal program which, conveniently, started in April of this year.  But the contract-signing part dragged on and on.  It was a nail-biting experience since our training team was waiting in the wings with airline tickets reserved and I was working long nights perfecting the art of panic.

On March 31, 2010, they signed the contract. For all intents and purposes, it was a go and I was able to sleep through the night (only to wake up on April Fool’s Day wondering if it was a joke—it wasn’t).

This new program will provide a foundation that will demonstrate to the Provincial Dept of Health that the construction of new adolescent wings within our two major launch hospitals is an imperative. I was once told by a high-ranking government official that “first, you must prove that you can work in the conditions provided.”  Then, she added, “ If you can make it work, they will build you space.”  So we’re cramming ourselves into unused waiting areas adjacent to abortion clinics for the first round of pilots. And we’ll make it work.

One pediatric physician was concerned that her HIV + kids would be left out. Not so.  Those already living with HIV will be educated in terms of prevention of transmission (commonly referred to as “prevention for positives”) alongside those without HIV.  Since all the sessions are run in groups of 10-20, this will build a sense of fellowship and reduce stigma.

That same physician expressed worry about the work burden on her staff. No need to fret, I said.  The “Let Us Protect Our Future!” campaign is designed to be self-sustaining through the employment of people like Nomalizo Nonkwelo who was recruited from a de-funded prevention education project in Duncan Village. For a minimal financial output, the hospitals will maximize the reduction of repeat cases of abortion, STI treatments, etc. through empowering their most vulnerable patients.  In the long term, we’ll be reducing the burden.  In addition, we have integrated the National Campaign for HIV Counseling and Testing into the curriculum.  All participants will be referred for HIV-testing if they have not already been.

During my last conversation with the Chief of Clinical Governance (an amazingly calm and collected woman despite her incredibly-stressful post) stated, “I hope you are ready to be very busy.  Every hospital in the Eastern Cape will want this campaign once we’ve completed the integration in our two hospitals.” Her assertion is great news, indeed!  We’ll just have to muster up the energy (and funds!) to make it happen.

Once the pilots are completed and the campaign is successfully integrated, we anticipate drawing on even more of the de-funded agencies to hire more staff to hopefully enact this program in all hospitals throughout the province (but I’ve got my sights set on the entire country). It’s a lofty goal, but I have a capable, eager and determined team with a vested interest in stopping the epidemic in its tracks within this demographic.  I’ve also been told that I’m too idealistic and that burn-out is right around the corner.  Perhaps, but if South Africa foresees a future free of HIV, directing initiatives and funds toward the highest-risk populations in the highest-risk settings is key to making this happen and we’ll just have to buck up and deal.
– Craig Carty, “Let Us Protect Our Future!” campaign

Maybe this by-line should be “Craig Carty, Bureaucratic Machine-slayer”. Bravo to you for having the meetings about having meetings, and for getting your vision to the table. I could not be more impressed, my friend.

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Do-goodery on wheels (Call for sponsorship)

The Friends for Life Bike Rally is an annual week-long cycling trip (Toronto – Montreal) fund raiser with proceeds going to the Toronto People with AIDS Foundation. If you live in Toronto, you might know somebody who’s done or is doing this amazing ride. I do, and I’ve offered to help him publicize his effort through the blog. Why? A couple of reasons: The FFL rally is a creative and interesting fund raiser for super-good cause, and Christopher is a fellow soccer player having his own adventure in do-goodery.

Also, after watching him dance around in various states of undress, a little PR was the least I could do. Let me explain: Christopher Hayden’s alias is Bruin Pounder, and he’s a performer in BoylesqueTO, Toronto’s all-male burlesque troupe. He’s also the founder of the ARTWHERK! Collective, and an all-around good guy. Though he’s not sharing all of his plans for the event just yet, he confides that Bruin will making an appearance somewhere along the 660km ride.

“This will be my first year participating in the ride,” says Christopher. “One of my main interests in this event is supporting the PWA. They have been leaders in providing support to people living with AIDS in Toronto since 1987. This isn’t something I’m doing necessarily as a gay guy, because HIV/AIDS affects people from so many different communities. I am doing the ride to support my city, promote HIV/AIDS prevention and to help provide services to people that are living with AIDS. Money is great but so is participation. We owe it to our communities to tell stories and advocate for things we believe in.”

What do you get for your donation, you ask?

“Any donations over $20 get a tax receipt … and my plan is to make a t-shirt with the names of all the people who sponsor me on it. I will wear it one day during the ride to show Canada who has got my back (literally and figuratively) for this challenge.”

Ready to make your tax-deductible donation and get your name on that shirt? Click here to reach Christopher’s donor page.

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