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INITIAL
THOUGHTS ON WHAT SHOULD BE DONE
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Addressing
an African summit on HIV/Aids, tuberculosis and other infectious
diseases, in Abuja (Nigeria) on 26 April 2001, UN Secretary-General, Mr Kofi Annan, called for action against the
world-wide scourge of HIV/AIDS, and outlined five key objectives for a global
campaign:
In an evident show of determination to champion the
fight against Aids in Africa, and possibly as the sequel to his call in
Abuja, he has just appointed an ex Canadian diplomatic, Stephen Lewis, as his
special envoy for HIV/AIDS in Africa.
Lewis is a former deputy executive
director of UNICEF, and was once his country's ambassador to the United
Nations. He is easily recognised as
an ardent supporter of various humanitarian causes around the world,
especially in Africa, and was nominated by the OAU to serve on the
international panel of eminent personalities, which investigated the 1994
genocide in Rwanda. Focus wishes him well and commends Mr
Annan for his timely intervention in the present climate of complacency,
vainglorious prevarication, and criminal inaction by national political
authorities. Mr Annan might also have
added to his objectives, specifically, the plight of rape victims of war, who
are made into unwilling carriers of the Aids disease but are very often
pushed to the periphery of official concern during the heat of prolonged
warfare. There is no doubt that in
Sierra Leone this has been the case for quite sometime. We have since come to know that several
young women and under-age girls were, and are most probably still being,
raped during the course of the civil war.
Writing way back in July 1999, with his usual stridency and chilling
frankness, the Sierra Leonean radio journalist Lansana Fofana reported this
trend, and concluded that the conflict had created
an upsurge in the incidence of HIV/AIDS. (See his report: Conflict
spurs the spread of HIV/AIDS). However, as we
have argued in the last two articles on this subject, HIV/Aids has visited
our country through various other agencies and the civil war is certainly not
the only culprit. For example, in addition to several reported cases of abductions,
sexual violence against women and girls, including rape, unwanted teenage
pregnancies and unsafe abortions, there are factors such as the nearly
universal aversion to the use of condoms among both the poor and educated
Sierra Leoneans, and other sexual behavioural preferences which cumulatively
present increased risks for transmission of HIV. The Task The primary
challenge for Sierra Leone now is for the country's authorities to take speedy
advantage of the concerns that the world community is showing for this
disease, with greater zeal and determination than before. As one sees it,
in view of the potential threat of an explosion of this disease in our country, three
basic tasks confront us right now.
They are:
If these can be
achieved, or responsible and responsive minds and efforts can be focused on,
at least, setting up mechanisms to begin to address them significantly, then
national attention can thereafter, if not simultaneously, be concentrated on
those people who are already in the clutches of the disease, i.e. present
known sufferers. For them, our prime concerns can be paraphrased into two
main objectives, namely:
In truth,
however, none of these things will happen overnight even with the
best-intentioned and most committed government in place. There are several reasons for that, of
which the lack of resources is merely one. In making this call, Focus on Sierra Leone does not mean to downplay the tremendous
progress that has been made by concerned groups inside the country, which
operate in very difficult conditions under the aegis of the National AIDS
Control Programme. Nor can we proceed
without acknowledging the invaluable help given by UN agencies like WHO,
UNICEF and UNFPA, and NGOs such as the IRC, Merlin, and others, who have been
monitoring the health of the country ever since. All of them have carried out their operations with the backdrop
of the civil war, during prolonged periods of heightened insecurity,
restricted movement and the almost routine inaccessibility of most parts of the
country. If one adds the desperate competition
for scarce resources, and the evident lack of support and commitment from the
centre, the problems that they face become truly daunting. Thus, even they will admit that there
remains an awful lot of work to be done. Need for visible national
leadership commitment to the Aids programme In our second
article in this series of commentaries on HIV/Aids, posted
here on 31 May, we concluded with the following prescriptive paragraph for
the way forward: “There is HIV/AIDS in the country.
We cannot now turn back the clock. What is needed is a massive health
education and awareness campaign. Recent history has shown that the only
countries that have succeeded in minimising the spread of HIV/AIDS have done
so by being open, up-front and changing the attitudes and behaviour of the
population at large. Awareness of risks of unprotected sex contact (the
condom) and basic medical hygiene, e.g. not re-using needles (not easy when
medical supplies are scarce, but if the alternative is HIV/AIDS), are
essential. Real leadership, not scapegoating, is needed to confront and
tackle the problem, in the hope of meeting it before it becomes a widespread
national tragedy.” What we
have in mind, in addition to advocating a huge mass education campaign about HIV/Aids,
is the need for a far more visible and instantly recognisable commitment by
the country's political and civic leadership. The
Abuja conference, to which we earlier referred, agreed a framework for
action, with a set of priorities, which was approved by all the leaders
present. It placed at the very top of
these priorities the need for the
“leadership at national, regional and continental levels to mobilize society
as a whole to fight HIV/AIDS, TB, and other related infectious diseases”
and recommended “the provision of an
enabling environment at all levels of leadership in society” as the best
strategy for carrying it out. Also
earlier, in his speech to that conference, Secretary General Annan had put
the onus squarely on the shoulders of African leaders themselves when he
said: "First of all,
we need leadership. And, my friends,
that must start with you, the leaders of Africa. Only you can mobilise your fellow-citizens
for this great battle. Only you can
give it the priority it deserves in your national budgets. Above all, you must take the lead in
breaking the wall of silence and embarrassment that still surrounds this
issue in too many African societies, and in removing the abuse,
discrimination and stigma that still attach to those infected. The epidemic can be stopped, if people are
not afraid to talk about it." More
recently, the much-respected Washington Post columnist Jim Hoagland alluded
to this need for sustained governmental action in an article on 16 May, in
which he commented that, “AIDS is a
deadly disease that needs to be fought by national governments, with
significant international help for the world's poorest countries. But fighting this modern plague requires
focus, discipline and a hard-nosed realism that has too often been absent in
the help industrial nations have extended to needy nations in the past.” Hoagland then listed four obstacles
or, as he described them, ‘horsemen of the Aids apocalypse’, namely, fear,
ignorance, poverty and, rather pointedly, politics. We agree with him! Politics
is one major reason why Aids has found our countries to be good breeding
grounds for manifesting its virulence.
This must be so because, when one considers the experience of
countries that have been successful in stemming and then controlling the
disease, progress has been achieved only when there is collaboration between
the government and various sections of the community. Thus the lack of formal, structural,
collaborative links between politicians and community organisations leads to
inaction, encourages a state of denial, and cultivates a culture of
complacency about HIV/Aids. But where the government takes a lead in working
closely with local/public health authorities, the media, businesses,
religious as well as community-based organisations, it can achieve instant
successes. For example, it can use these links to inform the public about
Aids, dispel the myths associated with the disease, and move the country from
fear to preventive actions, which can be incorporated into community-based programs. The need for links with businesses and
companies operating in the country is self-evident because, apart from the
issue of their corporate and social responsibilities, companies
should know that it would be
reckless for them to ignore the threat posed by the
harmful effects of the HIV epidemic on their operations, including wiping out
their workforces. Truth-telling or merely
being alarmist? It is
tempting and easy to be alarmist or sensational about HIV/Aids. Focus will not fall into the trap.
Knowing the facts as much as we do, which seem to point to a major calamity
in the making, we will not encourage Sierra Leoneans to become complacent.
But what we can and will do, is to draw attention to the
regular warnings, especially early signals, which those who have expertise in
these matters have given in the past, and continue to give presently. Since1981 when the first cases of Aids
came to light, they say that the disease has claimed 21 million lives, the
equivalent of nearly 1 million a year world-wide. Of this huge (and ever
rising) number, 17 million are said to be of African lives. (Table: An
African Plague).
Although hundreds of thousands have been saved from the infection
through preventive action and by the application of new advances in
treatment, poor African and other third world countries including our own,
are yet to benefit from such techniques on any appreciable scale. As far
as early signals go, how widely known is the survey report about Sierra
Leone, conducted by WHO in September 2000 and funded by the World Bank, which
prospectively flagged the HIV problem? This report stated that “past figures suggest that Sierra Leone is
at 8-10% seroprevalence, which is about the level at which cases start to
grow exponentially”? (In lay
terms, ‘seroprevalence’ is the level of a bacterium or virus, in this case
HIV, that can cause disease, in a population as measured in blood serum, e.g.
see
this prevalence map.) It also cited one medical doctor, who
described the country's "emergency
situation" as "a lethal
mix for HIV transmission”, adding ominously that “population displacement, rape, occupying troops, women in desperate
circumstances, insecure blood supplies, drug abuse, unsafe sex practices and
insufficient control activities all add up to a disaster”. There have been many earlier reports with
similar sounding alarm bells. Another
difficulty that is always associated with the reporting or discussion of Aids
is that of taboos. In effect, the problem boils down to a consideration of
how to expel the myths surrounding the disease, and break the silence and
stigma that is still all too often associated with it.
Public
acceptance
The
issue of the public’s acceptance is crucial.
This point was made succinctly by a South African student, who is
currently a Fullbright scholar doing a PhD in the US and also HIV
positive. Ngcoya, as he is simply
referred to, made his comments during a visit to the State Department in
Washington on June 15. He said that
he was a firm believer in people talking, just talking about Aids, and added:
"If you go to all the funerals, nobody mentions
AIDS… The only way we can fight AIDS
is to talk radically about it…” “And when it is covered, it is not because people care
about those who are dying, but because of the policies or the political
implications of the disease… The only
way that the world can change, the only way that we can progress through the
problem of AIDS is by talking about it in an effective manner. Government policies can only change when the
people speak." Our limited and,
admittedly, hurried research for this commentary has revealed that there are
commendable on-going programmes in Sierra Leone to help combat the spread of
Aids/HIV. However, those people we
have talked to – and we have by no means talked to everyone involved in these
campaigns – have complained that the average Sierra Leonean is nonchalant and
alarmingly dismissive of both the dangers posed by the disease and the
various methods that have been put before them for combating the spreading of
it. Most people have dismissed out of
hand some of the preventive measures recommended to them, including
suggestions that they must change their sexual behaviours and practices, and
adopting preventive measures such as the use of condoms, etc. Two former Aids workers who took the
trouble to contact us by email since we commenced the discussion of this
issue, told us that the programmes for which they used to work, had often
been delayed or frustrated, and abandoned mid course because people saw them
as an intrusion into their private lives.
One person, whom we have talked to, who is still active in one of
these Aids programmes in Sierra Leone but is currently on a visit here in
London, said that many people held suspicions about the motives of the
campaigns and were under the erroneous belief that it was a conspiracy to
limit their families. Our contacts
were all agreed that in addition to problems of illiteracy and ignorance, the
public attitude to the disease was in general due to the noticeable absence
of a high profile interest and involvement by those who are, at least
nominally, the public face of the country. Lessons from other countries, near and far It
follows, that in order to kick-start a more robust and sustainable nation-wide
campaign in Sierra Leone, we need a positive, informed and committed
political and civic leadership, to front the national effort to fight
HIV/Aids. At present, there is no
evidence that our current leadership is alarmed enough by the existing
well-documented signals, some of which we have discussed in this
commentary. We are neither convinced
that the scale of the pending disaster has made any impression with them, nor
sure that they possess both the moral and political courage that is necessary
to mobilise the Sierra Leonean population towards an awareness of the dire
situation facing them. The prospects
therefore already point to a false start, which will be not be easy to
reverse. Nevertheless,
individual Sierra Leoneans are entitled, as Focus on Sierra Leone believes it too is, to contribute ideas to
the ways in which society can organise itself to confront, without
compounding, the problem. That
problem is simply: how to contain and treat the disease, and prevent it from
escalating and getting completely out of control. We emphasise prevention because it is the least painful, the
least expensive and least requires expertise. It is really down to the individuals and to civic society to
determine how they wish to organise themselves to fight such a campaign. The snag of course is that, from past and
current experience, Sierra Leoneans have not proved themselves to be good at
getting together to fight a common cause, if their attitudes towards one another
in facing their country’s civil war perils are anything to go by! Whilst
we remain in a cocoon of self-doubt and a self-serving state of denial, we
might care to look at examples from other countries where the disease no
longer poses a threat but has become a catastrophic reality for their
citizens, and how they have been tackling it in their respective ways. It is to be hoped that such examples can
be instructive in helping us first appreciate, then tackle with confidence,
the threat that the diseases poses to our own fragile and war-depleted
civilian population. Three countries
come to mind. We shall deal with them
briefly in turn. South Africa The
South African situation is one in which ideology, politics and economics have
conspired to make a tragic situation even more confused. Sierra Leone cannot afford the luxury of
arguing over who is to blame or where the disease came from. It is undeniable that sexual habit is a
contributory factor in the spread of HIV/Aids and, while change in habit is
therefore necessary, medical and therapeutic help, once victims are
identified, must be provided. The
mere existence of the disease should be a catalyst to ensure (a) its
eradication; (b) helping those who are exposed to the dangers of contagion;
and (c) treating those who have succumbed to the virus. Every means of tackling the disease must
be employed, be it preventive, curative, or diagnostic. There is no need to intellectualise on the
'ifs' and 'buts' of its history, origin, or prevalence in a particular class,
region, or whatever. While
one sympathises with the SA President’s unarguably sound intellectual
position on his country’s affliction, which has been grossly misrepresented
by the Western media – for which he must take a fair share of the blame - the
bottom line is that his country has one of the largest numbers of sufferers
and fatalities. Therefore, the sooner
President Mbeki and his government accept that ideological considerations are
not the answer to the health and well-being of their citizens, the better
will be the auguries for a realistic assault on the epidemic across the rest
of Africa. After all South Africa, at
this very moment, potentially stands as a giant beacon for the rest of Africa
to follow. It must therefore give
progressive leadership in this and other areas of nation building. Zimbabwe Zimbabwe
is a different kettle of fish. Sierra
Leone stands the risk of ending in a similar position to it. In that country, the HIV/Aids awareness is
believed to be almost 100% and proper mechanisms and organisations have been
set up to address the problem.
Unfortunately, this level of awareness has not been matched by any
real success. One drawback has been
the unwillingness of the population to change behaviour and practice. Last year, the government took a bold leap
and imposed a further 3% levy, on top of income tax, on Zimbabweans,
specifically for a nation-wide AIDS programme. Zimbabweans characteristically rose to the challenge and gladly
accepted the extra imposition. Huge
sums were collected into the Treasury. But,
guess what? Corruption!
Corruption! Corruption! According to a UNAIDS report, "about 15% of the many millions of
dollars that have been collected, has been disbursed, and the whereabouts of the rest are unknown. That which has been disbursed is also the
subject of great debate, as there are now many hundreds of 'organizations'
springing up all over the place, claiming to support Aids victims and their
families, and all wanting a slice of the cake!" Fancy
that! Less than 15% of the funds have
been applied and the rest, over 85%, has just disappeared into thin air! In addition, bogus ‘die-man’ groups are
staking their claim to a share!
Nothing less than exploiting the sick. Zimbabwe's tragedy is further compounded by the staggering
revelation that the death toll each week is over 2000 and that the most
educated are apparently the worst affected. This is
one road down which Sierra Leone need not go. But with corruption still at the heart of government and public
services in our country, the chances are that such initiatives will suffer
similar abuse not least by the very people who would be charged with their
implementation unless, by then, conscientious people are at the helm of the
country’s affairs. Other African examples Other
African examples of note include Senegal
where Government policies were drastically changed when the prevalence of
HIV/AIDS began to rise; Senegal's infection rate is now less than 2%.
Zambia, the proportion of pregnant teenagers who have been
infected with HIV has fallen by almost a half over the past six years. Uganda
is fortunate in that its President has actively fronted the national attack
on Aids, which has led to a drop in the proportion of the total population
with HIV from 14 to 8 per cent.
Tragically, paradoxically, in efficiently run diamond-rich Botswana, statistics say that about
one in three adults are already HIV positive - the highest rate in the
world. It is said that at least
two-thirds of today’s 15-year-old boys will die prematurely from Aids. The government has consequently made the
fight against Aids its top priority, and has earmarked the profits from the
sale of the country's precious commodity to fight the disease. Thailand Far away
from Africa, the success story is that of Thailand. Here, the most successful national programme is under the
patronage of a member of their royal family, Princess Soamsawali, the wife of
the Crown Prince and heir to the Thai throne. She actively, rather than nominally, spearheads the Thai Red
Cross Zidovudine Donation Programme, which has successfully raised funds from
public donations to subsidise the drug, zidovudine, for HIV-infected pregnant
women. Thais have been less exercised
by ideological considerations of monarchism, feudalism, republicanism or whatever
and more by the content and focus of the leadership that the Princess is
giving in their country's assault on HIV/Aids. In this respect, she is playing a similar role to that by the
late Princess Diana of Wales, who selflessly lent her high profile support to
the campaign against the use of land mines. In brief, the success of the
Malaysian assault on the Aids epidemic has been put to:
This is
a noteworthy example, which we recommend to Sierra Leone to emulate. However, we wonder from where or from whom
the much needed national leadership and drive will come. Conclusion Sierra
Leone has all the warnings it needs.
We also have the experiences, including the successes, failures, and
mistakes of others, from which we can learn and draw lessons. We have the declared commitment of the
whole world community to mount a global assault on Aids. The least that we can expect from
especially our political and community leaders is for them to seize and take
advantage of the opportunities before them, using all the avenues that are
being offered, to mount a sustained attack on this scourge before it
decimates the present and future generations of Sierra Leoneans. © FSL Further
references:
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