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Help Me Raise A Voice For Africa’s Pregnant Women
WHILE governments in sub-Saharan Africa continue to dole out money on military hardware, teargas canisters and baton sticks etc., pregnant women in the region are dying in droves due to lack of proper healthcare. Paradoxically, women and girls are the main caregivers for the sick in the absence of proper health systems. Yet when they need care the most during pregnancy it is not available, a scenario made worse by gender inequities that put the lives of women and girls at risk.
The statistics are downright shocking. In sub Saharan Africa, 1 in 16 women is likely to die as a consequence of pregnancy and childbirth, according to a recently published report titled “Measure of Commitment: Women’s Sexual and Reproductive Risk Index for Sub-Saharan Africa”.
For many women in the region, particularly in underserved remote and rural areas, getting pregnant is akin to a death sentence.
“Pregnancy is dangerous business in Sub Saharan Africa where a woman is 100 times more likely to die from pregnancy related complication than in a developed country,” states the report. Read the rest of this entry »
The Great Vasectomy Fear
For most men, the idea of vasectomy, a surgical procedure to cut and close off the tubes that deliver sperm from the testicles, is a complete no-can-do associated with being sexually dysfunctional in the male psyche.
According to the latest issue of Population Reports, titled “Vasectomy: Reaching Out to New Users,” published by the Johns Hopkins Bloomberg School of Public Health, vasectomy is simpler and more cost effective than female sterilization and offers men a way to share responsibility for family planning.
“The most entrenched and powerful rumors concern manhood, masculinity, and sexual performance. Many men confuse vasectomy with castration and fear, incorrectly, that vasectomy will make them impotent,” says the report. But in fact, “Castration involves removal of the testicles. In contrast, vasectomy leaves the testicles intact, and they continue to produce male hormones.”
The procedure which typically takes from 15-30 minutes and usually causes few complications and no change in sexual function is one of the most reliable forms of contraception. Though it does not offer protection against sexually transmitted infections or HIV, for couples it is a way for men to be directly involved in family planning. Family planning has been largely seen as the responsibility of women but vasectomies allow men to play a part.
The report states that the largest number of vasectomized men are in China, where almost 7% of women in relationships — or more than 17 million couples — rely on vasectomy for birth control. Read the rest of this entry »
A Question of the Cutting Edge: Male Circumcision & HIV
Male circumcision (removal of the foreskin of the male penis) is increasingly gaining currency as an alternative method to reduce HIV-infection. In sub-Saharan Africa, the worst affected region in the world, male circumcision (MC) could prevent six million new infections, researchers say.
In fact, evidence from observational studies in sub-Saharan Africa has shown that circumcised men have a lower risk of acquiring HIV infection than uncircumcised men. A study in South Africa showed that male circumcision might reduce by about 60% the risk of men contracting HIV through sexual intercourse with women. The study focused on 3,000 HIV-negative, uncircumcised men ages 18 to 24 living in a South African township. Of these, half were randomly selected for circumcision while the other half remained uncircumcised and served as a control group.
For every 10 uncircumcised men who contracted HIV, about three circumcised men contracted the virus. Researchers believed the findings were so significant they deemed it was unethical to proceed without offering the option to all males in the study.
The argument is that the inner surface of the foreskin contains Langerhans celles, which have HIV receptors, and is also vulnerable to traumatic epithelial disruptions during intercourse. Second, an intact foreskin exposes a man to a greater risk of ulcerative sexually transmitted infections, which in themselves are a risk factor for HIV acquisition. Furthermore, the virus’ chances of survival might be higher in a warm, wet environment like the one under the foreskin. Read the rest of this entry »
New Moms in Africa Fight Postpartum Depression
Across sub-Saharan Africa, new moms are at risk of falling into depressive states that can potentially damage their own mental health and well-being of their new born child.
In many parts of the continent, public health systems are ill-equipped to deal with post-partum depression which affects a significant number of women after giving birth. The situation is made worse by the absence of psychiatrists or clinical psychologists trained to help women cope with the condition.
According to researchers, post-partum depression (also called post-natal depression) affects as many as one in five women, particularly during the first year of motherhood. Less than 2 in 1,000 women are also at risk of developing postpartum psychosis.
The condition causes mothers to feel exhausted and emotionally empty and can potentially destroy the bonding between a mother and her new-born baby.
“Women seem to be particularly vulnerable to depression during their reproductive years: rates of the disorder are highest in females between the ages of 25 and 45. New data indicate that the incidence of depression in females rises, albeit modestly, after giving birth,” reports the Scientific America journal.
According to the journal, dramatic hormonal fluctuations that occur after delivery may contribute to postpartum depression in susceptible women, but causes of the disorder are not fully understood.
“A longer term consequence of not diagnosing and treating postpartum depression is the effects it can have on the family, including the parental relationship and the development of the child. Children of depressed women have been found to have attachment problems, higher rates of behavioural problems and lower vocabulary skills,” states a report titled Postpartum Depression: A Literature Review.
For some new moms, the situation can be so severe it can lead to cases of infanticide and suicide.
However, among African women, little to no studies have been conducted to better understand the condition, and the way that women cope in the absence of appropriate public health services.
It is possible to surmise from existing data from other parts of the world the general experience of African women following childbirth.
A study by the University of Iowa revealed that low-income women are much more likely to suffer from postpartum depression than wealthier women.
The research revealed that women who are poor already have a lot of stress, ranging from poor living conditions to concerns about paying the bills.
The birth of an infant can represent additional financial and emotional stress, and depression negatively impacts the woman’s ability to cope with these already difficult circumstances, according to the study.
The study which focused on a sample of 4,332 new mothers from four Iowa counties showed that that compared to white or Latino mothers, African-American mothers are more likely to experience depression after having a baby.
Furthermore, the study revealed that African-American women tend to have weaker support networks, a major predictor of postpartum depression.
Like African-American women, African women that give birth are also affected by low incomes and high levels of general and live in stressful contexts which increases the onset of depression.
While there is clearly a need for more research into the coping methods of African women, simple screening methods can be utilized to identify women that are at risk of postnatal depression. Nurses in public health settings need to be provided with training so that they are able to detect and assist new mothers from post-partum depression. The use of a simple tool, the Edinburgh Postpartum Depression Scale, translated into local language, can assist nurses, family members and new moms to detect depressive symptoms.
If anything, public educational and awareness raising programs or simple pamphlets and posters describing the condition need to be displayed in ante-natal clinics so that women are mentally prepared to deal with the problem.
As research shows, social support networks can also play a key role in helping women deal with postnatal depression.
Overall, it is essential for national government throughout the world to guarantee that new moms have access to clinical and maternal services that can help to avert the emotional upheavals associated with giving birth.
How US could save lives with Female Condoms
Although the female condom has been heralded as a way for women to protect themselves from HIV and STI infections, its impact has been severely limited due to several reasons including its design, cost, access, stigma, and lack of political will.
Given the fact that women are the most affected and infected by HIV (in 2007, women represented half of all HIV infections worldwide, and 61% of HIV infections in sub-Saharan Africa) it is an imperative that evidence-based measures be undertaken to reduce their vulnerability.
The female condom is an essential sexual reproductive health tool that women can control but, disappointingly, it remains confined to the fringes of the response to the global AIDS epidemic.
According to a report by the Center for Health and Gender Equity titled “ Saving Lives Now: Female Condoms and the Role of US Foreign Aid” the US has an important role to play in the procurement, distribution and programming of female condoms.
As a leading provider of funding for HIV and AIDS prevention, treatment and care, and reproductive health supplies worldwide, the US can promote the wider use of the female condom, including reducing the cost which is beyond the reach of many of the affected women.
The report notes that there is little knowledge among policy makers and advocates about what the current US role is and, thus, a lack of understanding of what more the US should do.
“Bureaucratic obstacles, funding restrictions, and a lack of high level commitment to female condoms have significantly hindered the expansion of U.S.-funded female condom distribution efforts,” says the report.
“The U.S. government has no policy guidance encouraging missions or contractors to promote female condoms, which has meant that female condom procurement is dependent on a few field-level champions who are committed to the method,” adds the report.
Currently, international donors and government are investing millions of dollars and energy into promoting initiatives such as male circumcision, and little attention is being paid to promoting female condoms which allow women to initiate protection.
“While the unique nature of female condoms in providing women with their own source of protection should be reason enough for donors and governments to promote the method, female condoms hold other advantages as well. They fill their own niche, as consumers often alternate their use with that of male condoms, thus increasing the total number of protected sex acts,” states the report.
“They can be used by women living with HIV who do not wish to become pregnant, to protect against superinfection and to reduce the chance of HIV transmission to seronegative partners.”
In addition, female condoms also provide an additional option for protection during anal intercourse for men who have sex with men and heterosexuals, says the report.
In spite of the apparent benefits of the female condom, there are still major challenges in promoting its use.
Apart from the fact that female condoms are prohibitively expensive in many parts of the world, users find them noisy, physically unappealing, or difficult to use.
“However, female condoms are a cost-effective mechanism for HIV prevention when measured against thevcosts of potential HIV infections or other HIV prevention mechanisms. Also, as more and more female condoms are produced and purchased, their cost will drop,” states the report.
With greater financial investment and commitment, the design of the female condom can be improved increasing the likelihood of uptake by women.
Furthermore, there is need for educational and social marketing programs aimed at reducing the stigma associated with use of the female condom as well as improving consistent and accurate use.
According to the report, civil society groups can be extremely valuable in developing effective programming because of their access to populations vulnerable to HIV infection and their experience working with these groups.
The report makes the following recommendations to improve US’s role in the distribution and use of female condoms:
- USAID and OGAC should issue policy guidance promoting female condom procurement and programming within US-funded development programs, including PEPFAR. As a signatory of ICPD, the US should promote female condoms as a vital tool to prevent both pregnancy and HIV infection.
- The US should expand technical assistance for female condom logistics and procurement to additional countries to increase HIV prevention efforts.
- The US should apply intensive programming efforts to an additional three countries for scale-up and replication. These efforts could be used to create a more realistic assessment of global female condom needs for scale-up.
- The US should increase HIV prevention efforts by expanding the scope of female and male condom promotion to encompass the general public. Programming for female condoms will depend on each area’s epidemiological profile, and should be free of messages and attitudes that stigmatize condom use.
- The US should invest more funds in female condom promotion and programming. The US should subsidize female condoms for PEPFAR-funded programs.
- At the country level, the US should include civil society, especially women’s health and rights groups, in stakeholder meetings and encourage financing mechanisms that increase government-civil society collaboration in female condom programming.
- Congress should remove all earmarks and funding directives for abstinence-only, abstinence-until-marriage and fidelity prevention programs and fund comprehensive, integrated, and evidence-based HIV prevention programs that include female condoms and that promote and protect women’s health.
Young Couples Face Baby Pressures
Zimbabwean culture, like many cultures in sub-Saharan Africa, places a high value on procreation. Child-bearing is regarded as a rite of passage into becoming a normal adult member of society.
As a result, reproductive health choices and practices often play second fiddle to pressures to reproduce that are exerted by traditional and cultural norms. Usually, these pressures are covert so they tend to be ignored in the design of reproductive health programs and interventions.
Reproductive health generally implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.
But in Zimbabwe, men and women’s ability to exercise this right is curtailed by the unseen force of tradition and culture.
In many parts of the country, a woman is expected to have been married at roughly age 24, and within two years of marriage is expected to have a child. Young women, in spite of their educational status, are under immense pressure to fulfill this social expectation. On the other hand, a man who goes beyond 30 without getting married or having a child attracts significant social ridicule.
Failure to procreate especially in a marriage, even if it is by choice, is interpreted in negative light and is equated to reproductive health failure. For a man, becoming a father is associated with a sense of achievement, and failure to reproduce severely undermines the sense of masculinity. A woman’s place within a marriage is regarded as secure when she reproduces. If she fails to do so, she can become ostracized within the household and community.
“Failure to reproduce can strain family and other social relationships, particularly when the negative views of extended family members are taken to heart,” says a study conducted in Zimbabwe in 2001 titled Culture, Identity and Reproductive Failure in Zimbabwe.
“Generally speaking, about one year after entry into marriage or a stable sexual partnership, others expect there to be a child, irrespective of the reproductive choices of the partners.”
It is clear that traditional and cultural attitudes play a significant role in how both men and women construct their reproductive capabilities and choices.
As Danielle Toppin notes “given the often covert nature of socialization, certain gendered behaviours are often left untouched, resulting in reproductive health policies that fail to meet the specific needs of women, and of men”.
In Zimbabwe, the family, a primary unit of socialization, is often the root of pressure for men and women to prove that they can reproduce. The desire to conceive in order to gain social acceptance is given preference to adopting tools and methods that promote safe sex.
The social pressure on women to become pregnant and give birth leads them into conditions of vulnerability, where they have to acquiesce to their partner’s sexual demands. It can also lead men to have multiple sexual encounters exposing them to a high risk of contracting HIV.
Put simply, the effectiveness of sexual and reproductive health tools is inhibited by culturally and socially constructed layers that define people’s sexual behaviors.
However, instead of being an impediment, culture can be used as a stepping stone to promote reproductive health rights. To have effective reproductive health programs, therefore, a full understanding of a given society’s values and beliefs is required.
There’s need for an approach that is sensitive to contextual, cultural, traditional and gender practices that impact on reproductive health choices.
The traditional, spiritual and cultural beliefs that shape and define sexual identities and attitudes towards sexual and reproductive health need to be given serious attention in the design of programs and interventions. Traversing the cultural and traditional can be very difficult and requires a lot of sensitivity, investment and patience.
It’s imperative to involve the target communities in the design and implementation of reproductive health policy, planning and practice in order to challenge cultural norms that may put women and men at risk.
Strategic Communication for Health in a New Age
To respond effectively to the growing epidemics of AIDS and TB around the world, a strategy for communicating messages that influence change of individual behavior, community attitudes and socio-political dynamics is absolutely critical.
In order to make communication effective, there is a need to fully and rigorously understand the audiences, including contextual factors (political, cultural, economic, gender etc.) that determine the health choices people make.
The underlying factor is that communication does not occur within a vacuum, and thus it is essential to be aware of elements that may deter effective communication in the design, distribution and measurement of AIDS or TB messages.
Communication that saves people’s lives, improves health and enhances well being is about ideas, creativity, research, knowledge and money. Given the fact that resources are finite, strategic communication needs to consciously build upon existent social capital to ensure sustainability of processes.
Strategic communication can help to shape context and build relationships that enhance the achievement of objectives to respond effectively to AIDS and TB.
To be effective, strategic communicators must understand attitudes and cultures, respect the importance of ideas, adopt advanced information technologies, and employ sophisticated communication skills and strategies. To be persuasive, they must be credible.
More importantly, strategic communication for better health appreciates what works scientifically combined with flexibility to adapt it to specific cultural contexts.
As already stated, it should go beyond simply addressing individual behaviour to structural and institutional realities that are largely responsible for driving diseases and epidemics. In many ways, public policies tend to be responsible for social and health inequalities and cannot be ignored in the communication process.
Therefore, an effective communication strategy puts people and structural realities at its heart in the design, development, implementation and evaluation of messages.
In essence, strategic communication for better health needs to be informed by a process that identifies behaviours and attitudes, identifies policy priorities, and embarks on a process to influence a broad section of society through appropriate themes and messages.
In that respect, communication is not an end goal, but rather a means to influence dialogue and engagement through relevant mediums.
Labouring over which medium to choose when targeting a specific audience is a critical component in the communication for health process. In many ways, the medium defines the message in as much as does the target audience. A chosen medium has its limitations, and key messages and themes have to be aligned to the limitations of the medium to ensure effective message delivery. Obviously, the research-based needs of a target audience determine what delivery mechanisms to utilize.
It is important to know at the outset what goal seeks to be achieved with the particular choice of a medium so that the measurements of success or failure are specified.
Events, activities, messages, and materials must be designed with your objectives, audiences, partnerships and resources clearly in place. Building a communication strategy is about directing and focusing evidence-based messages and themes according to clearly defined pathways to achieve intended objectives.
The process of strategically positioning communication needs to ensure the participation of intended beneficiaries in the designing of messages, no matter what the level of focus.
Strategic communications shifts away from communicating to, and instead focuses on communicating with target groups in order to establish solutions., with emphasis being on how to build a relationship that allows for communication to take place so that appropriate action is taken. In that sense it is a significant shift from the magic bullet theory of communication which treats audiences as inactive recipients of messages.
Fact-based communication research is necessary for demonstrating and validating the need for resources required to increase the impact of communication. It is also essential that message platform for key initiatives are identified through the research process.
According to Wikipedia, “strategic communication provides a conceptual umbrella that enables organizations to integrate their disparate messaging efforts”. In other words, it enables organizations to “create and distribute communications that, while different in style and purpose, have an inner coherence”.
New media offers a significant opportunity to unify organizational health communications in order to achieve that inner coherence which is often times based on the vision, mission, goals and values of the organization.
New media offer an opportunity to encourage conversation and promote collaboration in creating appropriate messages. It is essential to integrate social media into the communication infrastructure and tap into its potential to create dialogue and reach a wide audience. New media make it easier and faster to communicate and collaborate, and essential element to public health communications.
The ability of new information tools to alter the way we communicate needs to be tapped into but as with any component of the health communication process the focus must be on people and not just the technology.
Overall, a strategic communication process needs to be planned, directed, coordinated, funded, measured and conducted in ways that promote the wellbeing of individual in a manner that aligns with organizational values and goals.
Zambia’s Voiceless Children
Lusaka, Zambia - Just a stone’s throw away from the posh Manda Hill Shopping Mall in Lusaka, Zambia’s capital city, little kids mill around traffic lights sniffing glue and pestering motorists and pedestrians alike for money, food and whatever else they can scrounge.
Many of the kids, dressed in filthy rags, are regarded as a menace to society due to their antisocial behavior. Near the traffic lights a big poster warns the public not to give money or food to the children, euphemistically referred to as “street kids.”
According to the poster, giving money or food only causes the children to remain on the street. Put in other words, the social menace that many of the nouveau rich in this leafy and suburban area fear will continue to grow.
Many of the so-called street kids are part of a generation of children in Zambia that is growing up without parental care, support or guidance. The children are vulnerable to exploitation, abuse and disease.
The United Nations Children’s Fund (UNICEF) estimates that there are approximately 1,250,000 orphans in Zambia — that is, one in every four Zambian children — with about 50 percent under nine years of age.
Orphans are defined as children who have lost one or both parents. The extended family network, a traditional safety net for orphaned children, is breaking apart due to the enormity of the HIV crisis throughout the country.
Additionally, the huge number of orphaned children is overwhelming national health, social welfare and education systems in Zambia, as in many parts of sub-Saharan Africa.
Most of the children face a bleak future, without parents to care for them and with little, if any, assistance offered by the government.
The children are often traumatized by the death of parents, stigmatized through association with HIV and often thrown into desperate poverty by the loss of breadwinners. They live under enormous pressure and suffer depression and other psychological problems.
Young girls, in particular, are the first to be denied educational opportunities in favor of boys and are forced into early marriages with older men, which put them at higher risk of HIV infection.
Children, both girls and boys, turn to the streets in search of a better life but the reality that confronts them can only be described as grim. Street life creates extreme vulnerability to violence, exploitative and hazardous labor, sex-work and trafficking.
In fact, internal trafficking of children has become rampant in Zambia. Sadly, there is little to no awareness of this social malaise.
Nothing short of a Herculean effort is required to help the growing legion of orphans in Zambia to lead normal lives. A holistic approach that includes provisions for nutrition, health and cognitive development, and educational and psychosocial support is required to effectively respond to the orphan crisis in the country.
Addressing these basic needs at an early age would give orphaned children a healthy start and a more-hopeful future.
Strengthening family systems and community care mechanisms is fundamental to this holistic approach because putting children into institutional homes can have a devastating effect on their self-worth and identity.
Furthermore, there needs to be a concerted effort to keep children in school because school is one recognized shelter that can help the children to discover their own potential.
The government must protect the children of Zambia with improved institutional, legal and social conditions, hopefully bringing an end the need to “protect” motorists from “street kids” at traffic lights.
The Fallen Grain
On a scorching day in Zimbabwe’s Buhera District, approximately 300 people queue to receive food handouts. All of them are beneficiaries of the food packs that local NGO Dananai Home-Based Care (HBC) has been distributing to people living with HIV and AIDS for the past five years.
Though Dananai HBC’s main mandate is to provide care and support to critically ill people living with HIV and AIDS it became apparent to the group that further interventions were needed to help improve patients’ living conditions.
In 2002, Dananai HBC partnered with Africare and WFP to provide food handouts in an attempt to meet the nutritional needs of people living with HIV and AIDS involved in the home-based care program and their dependents.
As the sun threw its hot rays across the sky, a slight easterly wind breezed through the slender gum trees at the local clinic, which serves as the food distribution point. The hordes of people chatted among themselves, some waiting for their turn to receive the food handouts, while others pushed wheelbarrows filled with maize sacks back and forth.
Some sat on the sacks, waiting for cattle-driven scotch carts to take them across the hot landscape to their homes. Meanwhile, an old woman crouched onto her knees and began picking at the grains of maize that had fallen to the ground, putting them slowly into a green plastic bag. As the bags of maize are pushed and shoved, some inevitably tear, and maize grains fall out.
Three women in the queue told her stop but she shot a retort back at them and they turned their attention back to the business of receiving food rather nonchalantly. The old woman began curtsying as she concentrated on picking the fallen maize grains.
‘We see this all the time. The people cannot tolerate the sight of maize grains on the ground. No grain can be wasted, so they pick it, one by one,” an Africare program officer responsible for overseeing food distribution said.
Africare, an INGO is responsible for the actual distribution of the food and the recipients of the aid are identified through the Dananai Home-Based Care project. If a recipient living with HIV dies, their family is allowed to continue collecting the food for six months before their handouts are cut.
The food handouts are popular in the community due to the high levels of poverty. The rainfall pattern in the area is erratic and subsistence farming, which many of the people in the district practice, has suffered immensely as a result. The district has experienced four consecutive droughts in the past decade alone.
“I have been to many households in the district, and many do not have any grain stocks. The situation is pathetic,” said Nonia Temberere, coordinator of Dananai Home-Based Care project.
Many of the households in the community are headed by women, either because they have been widowed or because their husband works and lives elsewhere. It is through the eyes of women that the impact of HIV and AIDS on this community is best reflected because they have been forced to work hard to feed their families as well as to provide care and support to the sick.
It is no coincidence that many of the people in the food queue are women. According to Africare workers, special care is taken to make sure that women are the main recipients as men tend to be less responsible with the provision of the stocks.
But the availability of food is creating a schism within the community and has resulted in increases in the numbers of people requesting HIV tests. Due to the levels of food, those receiving food through the home-based care program are perceived as better off than others because they have access to food.
So the demand for inclusion in the program is growing and hordes of people have been reporting to the HIV-testing facility at the Roman Catholic-funded Murambinda Mission Hospital.
“Some people get sad when they test HIV-negative,” said the coordinator of the New Start Voluntary Counselling and Testing centre, which conducts provider-initiated HIV testing at the Murambinda Mission Hospital.
If patients tests positive for HIV, they are immediately referred to the hospital or the Medecines San Frontieres (MSF) opportunistic infection clinic that distributes antiretroviral drugs (ARVs). Critically ill patients are incorporated into Dananai HBC programs through volunteer caregivers living in their community.
But testing positive for HIV is not enough and to enroll in the program patient must be on ARVs, in a critical and disadvantaged state and they must need food assistance.
This message does not seem to have reached some members of the community and there have been some accusations that community leaders, responsible for selecting beneficiaries, are biased and have only selected their friends and relatives.
As the old grandmother picked the fallen maize, it was clear from her bedraggled stature that she badly needed some assistance. She is, however, not on the list of beneficiaries and she is angry at the blood tests she took.
“I have taken three blood tests but they have not said anything to me. They can take more of my blood if they want, but for God’s sake, they should also give me food,” she said, scooping a handful of maize grains mixed with soil from the parched ground.
“I have a problem with my back from a pregnancy operation that I had in 1952,” she said, adding, “If my son was still alive, this could never happen to me.”
She pulls a wad of documents out of her green plastic bag and selects the record of her son’s death.
“I look after his three children. I also showed them this but they still refused to include me in the list. These organisations should go to the community and see the favouritism that takes place in the selection process,” she said.
“One of the problems is that as sick people receiving ARV treatment become well, and are able to perform normal duties and still receive food ahead of household that may be less privileged. There are always accusations of favouritism,” an Africare worker said. “The food is meant for those that are ill.”
According to Africare’s records, the number of people on the waiting list for food aid is overwhelming. MSF, which is also partnered with Dananai HBC, has seen a huge increase in the number of people needing ARVs.
The availability of food is one of the keys to helping Dananai HBC recipients to regain control of their lives. In the absence of nutritious food, the success of ARV treatments is severely compromised.
Many of the households in this district, which relies on subsistence farming, face food insecurity and find themselves hard hit by a disease that preys on society’s weakest. The challenges faced by Dananai’s HBC project mirror the challenges facing the country in general. At the heart of the problem is the need for food.
Poor access to water is also a problem for many communities. It is ironic that though the Bangure area in Buhera has the large 1970s Rundi Dam, the only benefit to the community is the supply of fish from the water catchment.
The need for food makes many of the communities in this area overly dependent on external assistance. Hungry stomachs appear to make many of the communities lie on their backs with legs crossed and lethargy seems to stalk the land.
The communities are just beginning to awaken to the need for HIV testing and the power of ARVs, but they are also fully aware of the fact that food security remains a big challenge.
Chief K.Masimba Biriwasha
