An inspiring endeavor that will undoubtedly change the face of epidemiological research  is being completed by a student. Jonathan Smith is an epidemiology student at Yale University who recently completed his thesis research on the HIV/TB epidemic in South Africa. He not only collected quantitative research, but also took the time to learn and understand the community. He is putting his work into a documentary film, but needs more support in order to make it a reality. The stories that he has to share are deeply moving and have the potential to make a big impact beyond the communities where he completed his research.

Support the film’s production here on KickStarter >> http://kck.st/ocZ5rn

I interviewed Jonathan this past week over email:

1. As a student from a Western country, why do you feel it is your place to tell the stories
of South Africans?

I really like this question – I don’t feel like it is my place at all. I am showing these stories, not necessarily telling them. My role in this project is to be a vector for their stories to unravel by themselves – then to stay out of the way! I think often times people do not appreciate the contextual differences in disease – any disease – and think what solutions work for ‘us’ will work for ‘them.’

This became real to me when I was living with Mr. Mkoko. I struggled to make headway in HIV education, prevention, and testing, at first, but eventually broke through with some success. Not by imposing what I was learning from school on them, but by working together, understanding the cultural beliefs of the community, and taking those beliefs seriously (not casting them aside as ‘stupid’ or ‘wrong,’ although they were indeed dangerously misleading). Because of this, I was formally accepted as a ‘brother’ into their community – even given the tribal name Masheshay’nike. This meant I was no longer an ‘umlungu’ (‘white person/outsider’) and that they now would respect my views and thoughts as one of their own – I worked with their traditional healer in a pseudo-scientific, quazi-clinic capacity that promoted proper prevention strategies and testing without undermining their traditional practices. This was an intense amount of work,
but if I were to just go in there and say “this is right, you are wrong,” I would have been shut out immediately.

2. Since there have been many fully funded large scale studies completed by international organizations, how has your work been received coming from a student?

For the film, I think being a student really helped me. People were really willing to help since I was just a student. I think it made the industry executives and government officials a little bit more relaxed – i.e. this was ‘just a student project,’ as opposed to a mainstream film, if that makes sense. Several production companies let me use their studios for interviews for free, international universities accommodated me, and people favorably responded to interview requests all because, honestly, I think they remembered what it was like being a struggling student.

3. How has your work been received in the epidemiological community since you
are using a mixed methods approach as opposed to sticking with traditional
quantitative research?

So it’s a little tricky – there are two things occurring simultaneously, but independently: a research project and a film. I am simultaneously working on a mixed-method research study at Yale that incorporates both qualitative and quantitative measures to indicate contextual factors that lead to increased TB and HIV vulnerability among this population. In other words, what other forces are at work that increase disease vulnerability and allow this cycle of disease to perpetuate. The film itself, while technically independent from the research, further investigates the lives of people caught up in the very cycle that I am researching. So puts a face to this and hopes to shift the conversation away from the data and more towards the person. Hopefully combined, they will really demonstrate a need for change – the data will explain that this is a widespread and serious problem (i.e. not some crazy activist film), and the film will demonstrate that for each ‘number’ that we quantify in the research, the impact goes well beyond just the statistics. So one does not negate or undermine the other, they actually go hand in hand to augment each other.

As far as reception from the academic community, people have been very receptive to the idea. I work with a number of professors at the University, and we are currently trying to figure out how we can expand on this idea, how to replicate it in other issues, as well as metrics to gauge its effectiveness.

4. What impact do you hope to achieve with the completion of the documentary?
What will your research and documentary be able to do that “million dollar” studies have failed to do?

What I think any research project on this issue has yet to do is place accountability. I’m in no way against the million dollar studies – we need them to highlight the problem. But over the past few decades, we have used this research to define the problem now with surgical precision – we know what it is. We know why. We know what needs to be done. We know how to do it. We know certain methods will work. But nothing is being done. Why? Because there is no accountability. Its not just ‘big mining’ dropping the ball – its everyone. Governments, the industry, and the unions could do more.

Even researchers. Because rates of TB and HIV are so high, researchers now use the mining
population for cohort studies that have nothing to do with the population itself, they just know they will get the disease so it would be an easy cohort study. They are literally human guinea pigs for epidemiological research. We are dancing a fine line of ethics when we treat a population int his manner.

I hope the film will educate and empower civil society to place accountability on the decision makers to actually get things done – to make the appropriate policy changes or actually enforce existing ones. I hope to string together motivated individuals and organizations to say, “Now we are watching.”

The AIDS Healthcare Foundation (AHF) has put together an amazing event to promote HIV testing and treatment among young people in South Africa. In a country where there is still a large stigma towards testing for HIV, especially among young people, this is a powerful example of using youth cultural influences to get the message across. AHF also offered free testing and counseling at the event.

What strategies have you heard of to get young people involved in their own health? Do you think hip hop can change people’s minds about testing for HIV?

While in Rwanda, I interviewed an HIV positive woman who told me about how she got married and had 3 kids with a man only to find out years later that he was HIV-positive and never told her. Her children luckily were not born with the disease but sadly she acquired it. She stayed by her husband’s side until his death and got treatment for herself. She is now combating the disease, taking one day at a time. This will make a large impact in the lives of HIV positive people as well as those who are in discordant relationships. Studies in the health sector are positively changing our world, providing a better life to those who can afford it but now also to those who cannot. For more information about this, please visit http://allafrica.com/stories/201109121887.html

With Hanukkah and Christmas in the past and Kwanzaa and New Years Day fast approaching holiday cheer and charitable acts are in full swing, along with the dollars fueling these two year end activities. Playing off of these charitable and cheerful feelings, the (RED) Campaign swings into full force at this time. The (RED) Campaign coordinates the marketing of “(RED)” branded products, such as Starbucks coffee merchandise, GAP t-shits and Nike shoelaces to “give up to 50 percent of their profits to the Global Fund to invest in HIV and AIDS programs in Africa.” In addition to the (RED) Campaign’s obvious ambiguity in regards to the amount of money actually given to the Global Fund, and the claim that the campaign is funding “HIV and AIDS programs in Africa,” without a clear description of what HIV and AIDS programs are actually being funded, the Global Fund is notorious for its lack of financial transparency. The Global Fund along with the (RED) Campaign is often questioned about its efficiency and efficacy, particularly in light of the huge media and marketing campaign that pulls in millions and millions of dollars from often clueless, though well-intentioned customers.

Not wanting to be totally Grinch-like, I must sing some praises of the (RED) campaign. For one, it has one of the most well known and ubiquitous charitable advertizing campaigns ever launched and sustained across a wide variety of products.  It has not only substantially impacted, and even changed the face of the philanthropic world, but has had an impact on the business world that fuels the campaign as well. And it cannot be denied that the campaign gives money to a large foundation whose goal it is to end HIV/AIDS, Tuberculosis and Malaria in African countries. And finally, buying a (RED) product will further benefit its stated mission in some way.

Regardless, there are two major things that make the (RED) Campaign inherently problematic. First, with such a powerful presence across a wide range of outlets around the world, shouldn’t the campaign do, give, devote, make, change, and affect more? And if it does, how do we really know?

And second, isn’t promotion of mindless consumerism ($200 iPods, overpriced T-shirts and Coffee, and running shoes made God-knows where by what age worker) contrary to the goal of public health in Africa, the ultimate goal of  the (RED) Campaign in the first place?

In fact, it may be true that goals and intentions of the (RED) Campaign are honorable.  But as consumers and producers in the developed world, we should be sure that our hard earned dollars, euros, yen and pounds, our charity to the less fortunate, and our holiday cheer make it to people and organizations that will use those things to the most effective and fullest extent. Although buying a red coffee cup, a red T-shirt, a red iPod, and red shoelaces are easy and fun ways to give, be sure of what you are giving and to whom you are giving it.

P.S. HAPPY HOLIDAYS!

P.P.S. Check out SCOUT BANANA’s own holiday campaign, TI(RED) for more information!

]]> http://scoutbanana.org/health-in-africa/happy-holidays-inc/feed/ 0 http://scoutbanana.org/health-in-africa/kamfinsa-aids-education-and-vct/?utm_source=rss&utm_medium=rss&utm_campaign=kamfinsa-aids-education-and-vct http://scoutbanana.org/health-in-africa/kamfinsa-aids-education-and-vct/#comments Wed, 01 Dec 2010 23:28:47 +0000 Guest Blogger http://scoutbanana.org/?p=1477 Ochas Pupwe is a Ph.D. candidate at Western Michigan University studying Applied Economics. Pupwe writes about his experiences working in the Zambian prison system promoting AIDS education, testing and counseling.

Ever since Camp Rising Sun (an international leadership camp) announced the ARISE PROGRAM ( a program for CRS alumni to fund community projects), it always kept bothering me that one day I should do a small project for my community. One day turned into tomorrow, and then tomorrow until the zeal would go. Thanks to the ARISE team for continuously encouraging people to be useful to their communities, and one night as I sat in my seat doing my night shift at one of the mobile communication companies, where I was attached for my internship, the common message came again from one of the coordinators” Apply for ARISE funding and make this world a better place to live in” At first I brushed it off, but because the night was quite long I decided to turn all those tomorrows I used to promise myself into a today, and believe me my life has never been the same.

Unlike the many other projects we get involved in, I should admit, going to do the project in the prison was a very intimidating thought. The first day of my endeavor was not easy, the bus I got on drove a number of miles to the outskirts of the city, and made a sharp turn into a corner of society most people live never to even imagine. The prison with all its stories of brutality, roughness, sodomy, seemed a wrong idea to me. But my true vision and will power to serve humanity revitalized my strength and as I stood before that big gate, almost looking that it’s dividing the city, I refused to give in to the trembling intimidation that had filled my heart.

“You may come in” ordered the prison guard. His tone not having any trace of tolerance, he seemed to be confirming my fears. With one gigantic step I moved into the prison premises, and though just at the reception I could sense that the aroma of the air had changed. This was indeed another world. To my surprise just after entry, there stood before me another equally strong gate, which I realized was obviously for enforced security.

The officer in charge was very nice to me and encouraged me to go ahead with the project, and pledged his support but as expected a good number of his subjects had their reservations when they heard the word VCT (Voluntary Counseling and Testing.) By this time I had started noticing the inmates, some in green who are convicted and others in plain clothes that are remanded.

A thorough insight of how the prison community operates helped me draw a program and before I could realize it on 23/05/03 I was moving in with Mr. Lalusha (Medical Officer) for our first AIDS education session. Mr. Lalusha for obvious reasons of his experience volunteered to carry out the first education session whilst I stood by as an observer, though his main mission was to carry out VCT.

When I looked at the inmates as I stood in front of them in the afternoon, I can confess that I have never spoken to a more attentive audience. Most of them looked frail from hunger, but despite this they were still very eager to learn.

We actually had problems in our first sessions in trying to convince the inmates that the program was ongoing as all of them where enthusiastic to come in at once, as none of them wanted to miss out on this one in a prison time experience. With the help of the prison chaplain we managed to divide them into 20 groups and hence conduct 2 sessions a week with 50 inmates per session. At the same time as the AIDS education sessions where going on the Medical officer was also carrying out VCT. Unlike the outside world, the response to VCT in prison was so overwhelming that at first we thought maybe they are just excited and would soon back out. But even after presenting and emphasizing the possible negative effects of VCT the inmates where still ready to go ahead. We further informed these prisoners that we had no medicine to offer but just the ability for them to know their statuses. The result of all this was the eager want for VCT from the prisoners.

After my first education session I should admit that I have never felt so good about something I have attained as I felt that first day of my project, their is indeed true happiness in serving others. I think Freddie understood that concept better and so did the funders of ARISE.  The education session went on well with inmates contributing and asking a lot of questions. The environment was relaxed and conducive for learning, no rough prison guards to intimidate the inmates where around, this was ensured with the courtesy of the officer in charge. With time we managed to finish all the male groups and just had one meeting with the female section. However we had to return to the female section because we had left some questions hanging, which needed the expertise of the doctor.

The most disturbing part of at the women’s section was the presence of children, who live with their mothers in prison. We are still yet to inquire what human rights implication that is .We however aren’t to dwell on this as it isn’t one of our objectives. Our focus in future maybe will be the risks these children in terms of HIV infection they are exposed to.

The peer counseling training handled by Rashida Bobb and Charles Lalusha was not only successful but also much appreciated by the inmates. About 5 months in the project, I had a different perception about the prisons, especially after having personal conversations with the inmates, despite the crimes they may have committed, the bottom line is “they are people” and like everybody else they need love. Far from what they are portrayed they are not rough barbaric animals from the moon, but some are our brothers, sisters and friends who have made mistakes in life, but despite this they are still a part of us, the human race!!!!

At the conclusion of the project we handed in reports to the government and Camp Rising Sun, but I would like to conclude that though a lot of work is being done in the field of HIV/AIDS, prisons are far from well served, and all well meaning organizations need to remember this neglected section of Society.

Thank you

South Africa has pioneered some of the most advanced medical procedures in the world. In 1967, Christiaan Barnard preformed the first human-to-human heart transplant, but still the majority of the South African population is without adequate health care. Cosmetic and plastic surgery has grown a “medical tourism” industry in South Africa while rural populations wait for doctors.

(Photo Credit: International Foundation of the Red Cross)

This week saw the continued striking of Nigerian doctors as well as  empty promises of stretched health ministries and US food aid. Our blog hosted a bright discussion on HIV/AIDS in South Africa highlighting the issues of Gender Based Violence and the use of pornography to influence health behaviors and education. Please let us know what you think in the comments, we’d love to start a conversation! If you are interested in submitting a guest post – submit here.

Sierra Leone: Unfulfilled Promises of Free Maternal Health Care for Mothers

Marie Musa, 37, is devastated. After the mother of four gave premature birth, her baby boy died a few hours later – because the hospital did not have enough incubators to rescue the infant. In August, the same month that Musa’s baby died in hospital, James Bamie Davies, commissioner of the customs and excise department of Sierra Leone’s National Revenue Authority (NRA), announced in a government gazette an auction of medical appliances, including eight incubators. Only the public outcry that followed the announcement of the auction in the gazette, did the Ministry of Health and Sanitation spring into action and recover the goods.

Uganda: Nine Million Face Hunger

As Uganda joins the word to mark World Food Day today, Isaac Khisa looks at Uganda’s strides in ensuring that every citizen has at least a meal a day Uganda today joins the rest of the world in celebrating World Food Day but with millions of its population still malnourished. According to United Nations Food and Agriculture Organisations, nine million Ugandans are still facing hunger with many affording only one meal a day. Uganda population is now estimated at 31 million, meaning that about 30 per cent of Ugandans can hardly find something to eat.

Zimbabwe: Diarrhea claims 4000 yearly

About 4 000 children die from diarrhoea in Zimbabwe each year due to poor hygiene and unsafe drinking water, a United Nations senior official said last week. In a speech read on his behalf at the annual commemorations of the Global Hand-Washing Day held in Mutoko last week, Unicef country representative Dr Peter Salama said hand-washing is the single most effective and inexpensive way to prevent diarrhoea.

Benin: Disease Spreads as Floods Continue

Two-thirds of the African nation of Benin is underwater, with at least 43 people killed and nearly 100,000 made homeless. Heavy rain began falling at the start of October, and the Rivers Oueme and Mono soon overflowed. Thousands of hectares of land, mostly used for growing rice and other vegetables are now underwater. “Here, the water isn’t going away. We have it up to our knees and now it’s as high as our thighs,” said one resident. “The water, it’s everywhere, and it’s very difficult for people to escape.

South Africa: The Real Health Deal

Health minister Dr Aaron Motsoaledi will today sign the “real deal” with nine provincial health MECs and eight ministers, giving South Africans a shot at “a long and healthy life”. The Negotiated Service Delivery Agreement (NSDA) gives a frank, but brutal assessment of South Africa’s healthcare system and at the same time commits “not to keep doing things as usual” in finding solutions.

South African adult film producer, Tau Morena has just released his newest film, “Mapona,” the English translation being “naked.” This adult film is unique for two unexpected reasons. First, the film makes an empowering political statement about race and South Africa. For the first time in the South African adult film industry Morena employed an all-Black cast. Although the majority of South Africa’s population is Black, this is a first for South African adult films. Second, the film promotes HIV awareness, education and prevention. Although unpopular in the industry, the cast was asked to wear condoms in the film, in addition to being tested for HIV prior to shooting. The South African adult film industry is the first in the world to make such a powerful and blatant health statement. [1]

Other sensationalized publicity campaigns have proven effective at delivering a health message. In Bangladesh, the Bangladesh Rural Advancement Committee (BRAC) launched a similar campaign a few years ago. BRAC’s founder, Fazle Hasan Abed, started a nationwide campaign addressing the increase in HIV infections. Abed’s campaign “condomized” the country with a wide supply of birth control and safe sex education programs. He placed ads all over the country, handed out condoms in public places such as restaurants, stores and especially focused on brothels throughout Bangladesh. BRAC’s campaign dramatically improved the HIV-related health of the country in an effective and radical way.[2] This campaign is similar to Morena’s new film because it brings important and oftentimes stigmatized health issues into public view.

Although “Mapona” is a new, progressive and interesting way to address the HIV epidemic in South Africa, is pornography the medium that should be used to make such a public statement? Using the medium of pornography as a social platform to supposedly promote racial equality and HIV awareness (both of which have a very dependent relationship) is a paradox in itself.  Using an all-Black cast to promote HIV awareness in an adult film could very well perpetuate the colonial and racist stereotypes in the hyper-sexualized images of Black people, especially in an African context.

Does Morena’s highly publicized film reflect a progressive and effective social statement, like BRAC’s HIV awareness campaign? Or is it a publicity stunt that, in the end, defeats the primary purpose of racial and health equality for Black South Africans?

Our guest blogger of the week is Anna Aulette-Root, a Ph.D. candidate and lecturer at the University of Cape Town in South Africa. Aulette-Root has done extensive research on the global health epidemic of HIV and gendered violence.

Activists, practitioners, and scholars in South Africa are currently looking at the significant role gender-based violence (GBV) plays in the spread of HIV. In contexts outside of South Africa, especially in the Global North, GBV is not commonly understood as a health problem. In the USA, for example, GBV is often thought of as a woman’s rights issue, or a psychological problem in men, or a problem best left to the criminal justice system. In the USA, GBV is not usually viewed as being a result of a combination of the above, and making the leap in understanding GBV as a health issue is virtually unheard of.

Certainly, in South Africa we see GBV as a social and human rights issue, but we pay close attention to GBV as a health issue. GBV is a problem that impacts the healthcare system in many ways and, importantly, it is an issue that impacts the health of individuals in South Africa and around the globe. Before we look at how GBV creates health problems, it is important to understand what exactly GBV is.

The term ‘gender-based violence’ encompasses any violence where gender plays a role (and if you think about this carefully, the argument could be made that any violence is gender-based). However, it is understood that this term includes violence such as intimate partner violence, domestic violence, physical abuse, psychological abuse, coercive sex, rape, economic violence, and intimate femicide. This list, for sure, is incomplete and many other forms of gendered violence exist. Perhaps the most well-known type of gender-based violence is domestic violence or intimate partner violence, in which (in heterosexual relationships) a man or boy is doing the abusing and a girl or woman is surviving the abuse. GBV/violence against women occurs because of the way gender is constructed (men have power over women) and also as a way of keeping the status quo (men use violence as a way of maintaining power over women). So what exactly are the health consequences of GBV?

GBV is a health concern in terms of the physical and psychological damage incurred by survivors. GBV has also been implicated as being intimately linked to the global HIV epidemic. We know that between 10%-60% of all women world-wide, will experience GBV in their lifetime.[1] We also know that the number of women living with HIV has been on the increase since the 1990s[2] and is now listed as the leading cause of death and disease in women world-wide. [3] Numerous studies have established and a number of scholars have written about direct as well as indirect links between GBV and HIV infection.[4] [5]

In its most graphic expression, violent acts such as rape or coercive sex may lead to HIV infection due to women’s bodies being ripped and torn—wounds make entryways for the virus. In addition, women in violent partnerships often find it difficult or even impossible to refuse sexual advances; persuade their partner to stop cheating; or seek treatment for abuse or STIs.2 And in terms of using condoms (which is the global message we all receive in curbing the spread of HIV), imagine the difficulties in insisting on or even negotiating condom use with a partner who is abusive? If an abuser is unwilling to stop their violence, it is likely they are also unwilling to heed the request of their partner to use condoms.2

So what does all of this mean and what can be done? The fact southern Africa has reportedly been particularly hard-hit in the HIV pandemic means that a great deal of attention, focus, and work has been done in South Africa (as well as in other nations on the continent) in finding solutions to this health crisis.  What scholars, practitioners, and activists in South Africa have found is that: unequal power between men and women in intimate relationships and the way that gender is constructed is furthering the spread of HIV and therefore, GBV is more than simply a social or human rights problem—it is a major health problem as well. If gender is constructed such that part of being a man means being violent toward woman partners and part of being a woman means being attracted to violent men—something has to give. South African scholars, practitioners, and activists have called for a fundamental change in the ways in which we go about educating people, intervening in, and treating people living with HIV. Rather than focusing on behaviors such as ‘abstaining, being faithful, and condomizing,’ our focus should be on transforming the ways in which we are ‘allowed’ to be men and women. This means envisioning a world in which there is no gender inequality; where being a ‘manly’ man might include caring for partners and children; where being a ‘good’ woman might include being strong and vocal; and where there is less need for recognizing so-called differences between the genders—for we are all human.

South Africans have paved the way for this goal of eliminating GBV, HIV, and transforming gender—these messages must now find their ways out to the rest of the world.

[2] World Health Organization (2009). Women and Health: Today’s Evidence Tomorrow’s Agenda. Geneva, Switzerland: WHO.

[3] Ribeiro, P., Jacobsen, K., Mathers, C. & Garcia-Moreno, C. (2008). Priorities for women’s health from the Global Burden of Disease study. International Journal of Gynaecology and Obstetrics, 102, 82–90.

[4] Jewkes, R. & Morrell, R. (2010). Gender and sexuality: Emerging perspectives from the heterosexual

epidemic in South Africa and implications for HIV risk and prevention. Journal of the International AIDS Society, 13, 6-17.

[5] Jewkes, R. & Morrell, R. (2010). Gender and sexuality: Emerging perspectives from the heterosexual

epidemic in South Africa and implications for HIV risk and prevention. Journal of the International AIDS Society, 13, 6-17.