Uganda Steps Backward with Anti-Gay Legislation

News from Uganda that the government is seeking to reaffirm penalties for homosexuality and criminalize the “promotion of homosexuality” will only serve to drive people of same-sex orientation underground. The implications for public health efforts are dire, and there is no doubt that if the bill is passed into law, it will deal a body blow to HIV prevention efforts.

In Uganda, as in many parts of Africa, the health of Lesbians, Gays, Bisexuals, Trans and Intersexual Peoples is marginalized. This sub-group is already faced many challenges including HIV, STDs and STIs, and mental health problems due to lack of access to services.

“This bill is a blow to the progress of democracy in Uganda,” said David Kato of Sexual Minorities Uganda. “Its spirit is profoundly undemocratic and un-African.”

According to the International Gay and Lesbian Human Rights Commission the Ugandan Parliament is now considering a homophobic law that would reaffirm penalties for homosexuality and criminalize the “promotion of homosexuality.”

The Anti-Homosexuality Bill of 2009 targets lesbian, gay, bisexual, and transgender (LGBT) Ugandans, their defenders and anyone else who fails to report them to the authorities whether they are inside or outside of Uganda.

The proposed law will effectively criminalize homosexuality, and consequently bar any person of same-sex orientation from seeking public health services.

AIDS home-based care in Zimbabwe in dire need of support

Girls

The HIV epidemic is shaking up Zimbabwe, like many countries in sub-Saharan Africa, and the shock is being reflected in the collapse of the public health-care system.

According to the World Health Organization’s (WHO) 2006 World Health Report, the African continent bears 24% of the global burden of disease but has only 3% of the global health-care workforce and 1% of the world’s financial resources.

The report identifies 57 countries that cannot meet a widely accepted basic standard for health-care coverage by physicians, nurses and midwives; 36 of these ‘critical countries’ are in sub-Saharan Africa.

The WHO estimates that it will take an additional 2.4 million physicians, nurses and midwives to meet current needs, along with an additional 1.9 million pharmacists, health aides, technicians and other auxiliary personnel.

In simple terms, the public health-care system can no longer accommodate the millions of ill people who require medical attention, care and support. Ironically, the money that is flowing into Zimbabwe to combat HIV has done little to resolve the problems of the poor and weakened public health systems – problems made worse by the ‘brain drain’ of qualified medical personnel.

Critically ill people, it seems, are being offloaded from the public health system onto the community. Increasingly, the burden of HIV care is being borne at the community level, particularly at the household level, where much of the care work and support costs for people living with HIV (PLHIV) are now being taken on.

Zimbabwe’s Hungry Stomach Politics

In the run-up to the June presidential run-off elections in Zimbabwe, President Robert Mugabe’s government banned the distribution of food to poor people by NGOs. The government accused NGOs of using food to campaign on behalf of the political opposition.

More than anything else the government ban on food distribution is a revelation of how much the stomach has influenced political developments in the country.

Zimbabwe is a nation-state that has been increasingly built on the politics of empty stomachs since it attained independence from British rule in 1980.

A combination of widespread rural poverty and a legacy of the liberation war have in many ways nourished President Robert Mugabe’s rule since 1980.

Mugabe’s Zimbabwe African National Unity-Patriotic Front (ZANU-PF) has mastered the art of handing out Lazaric crumbs to the majority of the people, particularly in the rural areas, in exchange for political gain and control.

It’s so sad, as her death was avoidable

By Godsway Shumba

Guest Blogger

 

“Lord! Give me another chance. I want to live and look after my children. They are still very young.”

 

Vimbayi (not her real name) repeated this prayer for several nights during her last days. In spite of her desperate prayers, she died at the age of 28, leaving behind two children.

 

Perhaps the saddest part is that her death was avoidable if she had had the correct information and people to support her.

 

A relative of Vimbayi, I finally got a chance to see her five months after hearing of her failing health. By that time, she was very weak. I asked her husband whether she had been tested for tuberculosis. He handed me her medical records.

 

At first, I thought that this was a breach of confidentiality. Later, I realised time was running out and we needed to do our best from an informed position. In my community, before HIV/Aids, people easily shared medical records.

 

But the Aids stigma changed the way people share information about their health.

 

The records confirmed that two sputum tests for TB had produced negative results. Unlike her husband, I also realised that Vimbayi had tested positive for HIV. As someone who was working in the HIV/Aids field, I knew the meaning of phrases such as “patient referred to OI (Opportunistic Infection) Clinic” and “post-test counselling done and positive living discussed”.

 

Prophylaxis treatment had been prescribed but I could not see any signs of it. She told me she stopped taking it two months previously because there had been no improvement.

In Zambia Young People Have Sex to “Prove a Point” or Make Money

Young men and women in Zambia are under pressure to engage in multiple sexual relationships due to prevailing societal attitudes about masculinity and for economic benefits, respectively, according to a study recently published in the African Journal of AIDS Research.

 

The study states that young men are likely to engage in high-risk sexual behaviour because that is the way men are expected to behave, with the majority believing that their identity is defined by their sexual prowess.

 

On the other hand, young women have multiple sexual partners as a way to escape poverty, which affects approximately 68 percent of the population.

 

“Among young women in the study, the practice of multiple sexual partnerships seemed fairly widespread and it typically involved powerful socio-economic ties, making it difficult for individuals to change their own behaviour,” said the study.

 

Young people’s sexual attitudes and behaviours comes against a backdrop of high rates of HIV and AIDS which have shortened life expectancy in the country.

 

According to UNAIDS, an estimated 16,5 percent (1,200,000) of people aged 15-49 in Zambia are living with HIV, of which 57 percent are women with the main mode of HIV transmission being heterosexual intercourse.

 

To make matters worse, UNAIDS reports that in Zambia there is also pressure on women to demonstrate their fertility, so they do not use condoms and a cultural trend for inter-generational relationships also puts girls at risk.

 

Statistics show that HIV prevalence peaks in men between the ages of 29 and 34; in women it is 15 and 24.Among young people ages 15-24, the estimated number of young women living with HIV in Zambia is more than twice that of young men.

 

In Zambia, like many countries in sub-Saharan Africa, epidemiological evidence shows that multiple sexual partnerships are contributing considerably to HIV transmission.

 

In light of this, there is need for increased emphasis on fidelity and partner reduction in the prevention of HIV transmission. However, a combination of cultural and economic factors push young people into potentially risky sexual engagement with multiple partners.

 

According to the study, although young people were aware of the risk associated with having multiple sexual partnerships, they described several barriers to translating safer-sex knowledge into health-promoting safer-sex behaviours.

 

“For many young men, having many partners was a way of demonstrating their virility and manliness,” states the study titled “Reasons for multiple sexual partnerships: perspectives of young people in Zambia”.

 

“It was seen as more acceptable for men than women to have multiple sexual partners.”

 

The study adds that a traditional culture that associates masculinity with having multiple sexual partners does exist among youth in Zambia.

 

“When respondents spoke about young men having multiple sexual partnerships in order to “prove a point,” it is evident that in essence the point they were trying to “prove” was that they could live up to the cultural expectations of masculinity in Zambia,” says the report.

 

Notions of masculinity have long been singled out as a stumbling block to safe sexual practices between men and women.

 

The study recommends that there is a need to challenge traditional notions of masculinity which puts both men and women at risk of exposure to HIV. Respondents also cited polygamy, which is widely practiced in some parts of Zambia, as a factor which influences multiple sexual relationships for young people socialized in a polygamous environment.

 

Effective responses to HIV and AIDS in Zambia, like many countries in sub-Saharan Africa, need to continuously figure out how to tackle often-sensitive cultural issues that facilitate HIV transmission.

 

Among young men, existent concepts of masculinity need to be redefined so that the definition of manhood is not simply confined to sexual prowess or number or sexual encounters.

 

The study further recommends that young women need to be offered more opportunities to escape poverty because this will reduce the need to resort to multiple partners as a means of survival.

 

“While the majority of the young people were well aware that having multiple sexual partnerships increased their chance of contracting HIV, it is vital that youth be made aware of the sexual networks that are created as a result of this multiple partnering – and how the chance of becoming infected can depend on one’s position within the networks,” states the study.

 

Overall, sex education can play a key role in encouraging young people to either delay having sex or practice safer sex.

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.

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.

 

 

Low Cost Technology Saves Poor

 

Most Zimbabweans -  about 70 per cent of the population – live in rural areas and are engaged in smallholder agriculture. These smallholder farmers, particularly in the country’s low rainfall areas, are extremely food insecure and have little or no access to new technology.

 

They suffer from low incomes and a generally low standard of living, poor health and nutrition, poor housing and an inability to send children to school. Soil degradation and outdated farming methods have kept rural families trapped in poverty.

 

Inadequate and unreliable rainfall and the recurrent threat of drought also restrict the potential of rain-fed agriculture, on which the livelihoods of most smallholder farmers depend. In a word, access to water for irrigation is one of the most critical constraints that small farmers face.

 

Making matters worse, AIDS is undermining agricultural systems and affecting the nutritional situation and food security of rural families. As adults fall ill and die, families face declining productivity as well as loss of knowledge about indigenous farming methods and loss of assets.

 

The devastating consequences of the epidemic are plunging already poor rural communities further into destitution as their labour capacity weakens, incomes dwindle and assets become depleted, with the latter affecting mostly women and children who have few property rights.

 

According to a survey conducted by the Zimbabwe Farmers’ Union, agricultural output in communal areas has declined by nearly 50% among households affected by AIDS in relation to households not affected by AIDS. Maize production by smallholder farmers and commercial farms has declined by 61% because of illness and death from AIDS.

 

Women and girls are especially vulnerable. They face the greatest burden of work – given their traditional responsibilities for growing much of the food and caring for the sick and dying in addition to maintaining heavy workloads related to provisioning and feeding the household. In many hard-hit communities, girls are being withdrawn from school to help lighten the family load.

 

The International Fund for Agricultural Development (IFAD) describes household food security as “the capacity of households to procure a stable and sustainable basket of adequate food” (IFAD, 1996). It incorporates: (a) food availability; (b) equal access to food; (c) stability of food supplies; and, (e) quality of food. All aspects of this are affected by both the household-level impact of HIV/AIDS and the wider impacts of a generalised HIV/AIDS epidemic.

 

In households coping with HIV/AIDS, food consumption generally decreases. The household may lack food and the time and the means to grow and prepare some food. For the patient, malnutrition and HIV/AIDS can form a vicious cycle whereby under-nutrition increases the susceptibility to infections and consequently worsens the severity of the disease, which in turn results in a further deterioration of nutritional status.

 

The onset of AIDS, along with secondary diseases and death, might be delayed in individuals with good nutritional status.

 

Nutritional care and support may help to prevent the development of nutritional deficiencies, loss of weight and lean body mass, and maintain the patient’s strength, comfort, level of functioning and self-image.

 

In effect, the nutritional status of HIV/AIDS patients can also help improve the effectiveness of antiretroviral therapy, when it does become widely available to poor rural people.

 

In such a context, labour-saving technologies that will adapt agriculture to new conditions generated by HIV/AIDS can help to compensate for the depletion of labour caused by sickness and death.

 

Drip-irrigation is a low pressure, low volume irrigation system suitable for vegetables, shrubs, flowers and trees, and can be helpful when water is scarce or expensive.

 

Already popular in countries such as Israel and India, drip-irrigation has been gaining attention because of its potential to increase yields and decrease water use, fertilizer, and labour requirements, if managed properly.

 

Drip irrigation (sometimes called trickle irrigation) works by applying water slowly and directly to the soil. It is the slow drop-by-drop, localised application of water at a grid above the soil surface. Water flows from a tank through a filter into lines then drips through emitters into the soil next to the plants. The high efficiency of drip irrigation results from two primary factors. The first is that the water soaks into the soil before it can evaporate or run-off. The second is that the water is only applied where it is needed (at the plant roots), rather than sprayed everywhere as in sprinkle or furrow irrigation systems.

 

Nutrients can be applied through the drip systems, thus reducing the use of fertilizers. Soil is maintained in a continuously moist condition. With a 100 square meter garden, equipped with low cost drip kit technology, a family of five can grow nutritious vegetables for consumption throughout the year.

 

This inexpensive kit offers a 50 per cent savings on water, over 80 per cent yields, and better quality vegetables and herbs. Because of its minimal labour requirements, the kit is well suited to serve HIV and AIDS affected households headed by orphans or their grandparents, where labour maybe in short supply.

 

In Zimbabwe’s rural areas, HNGs are widespread, yet they are largely neglected in spite of their potential to cushion disadvantaged and AIDS-affected families from food insecurity. Ordinarily, a HNG is cultivated close to home, thus eliminating the need for farmers to travel to distant fields.

 

HNGs can play a significant part in enhancing food security in several ways, most importantly through: 1) direct access to a diversity of nutritionally-rich foods, 2) increased purchasing power from savings on food bills and sales of garden products, 3) availability of food throughout the season and especially during seasonal lean periods, and 4) savings on water, time and labour.

 

Improving household gardening requires the optimal use of land and irrigation, as well as a dynamic integration of additional crops and crop varieties with specific value and uses. A well developed HNG has the potential, when access to land and water is not a major limitation, to supply most of the non-staple food that a family needs every day of the year, including roots and tuber, vegetables and fruits, legumes, herbs and spices.

 

Roots and tubers are rich in energy and legumes are important sources of protein, fat, iron and vitamins. Green leafy vegetables and yellow-or orange-colored fruits provide essential vitamins and minerals, particularly folate, and vitamins A, E and C. Vegetables and fruits are a vital component of a healthy diet and should be eaten as part of every meal, and are highly recommended for people living with AIDS

 

Smallholder farmers generally grow three cycles of crops per year. Typically, this includes at least one cycle of vegetable crops during the winter months, and an early maize or bean crop that can be harvested in December. The exact cropping cycles and systems will depend on regional climate, soils and input availability, in conjunction with the specific skills and nutritional needs of the household.

 

Farmers are encouraged to grow locally available indigenous crops that are highly nutritive but often neglected. The crops contain good nutrients and often require low labour-input. They represent a flexible source of food supply and can be easily preserved. Besides providing a source of income, they are adapted to cultural dynamics and local food habits.

 

They produce ample seeds without creating a dependence on external resources. Because the technology is new, smallholder farmers require technical support and training to help them tap into the full potential of the kit.

 

By strengthening the capacity to produce food at household level using low-cost technologies, negative impacts can be mitigated for AIDS-affected communities. Labour saving technologies and improved seed varieties can help to compensate for the depletion of labour caused by sickness and death, and assist farm-households to survive prolonged crisis, such as that caused by AIDS. Through agriculture and rural development, resilience against HIV can be built.

 

Drip irrigation technology offers much promise for landholders in the communal areas of Zimbabwe, where water application has traditionally involved the use of surface irrigation and “bucket watering”. Both methods are inefficient and waste a lot of water. Using the bucket involves hard work especially when the water is far away and scarce.

 

With drip irrigation, communal farmers, especially women, who are the primary carers and pillars of the community, can be able to maintain their gardens with ease, efficiently and at a low cost.

 

Also, drip technology will give quick returns on a small investment, and growing vegetables will provide both nutrition vegetables and year-round incomes.

 

As the old Chinese saying goes: “Give a man a fish; you have fed him for a day. Teach a man to fish; and you have fed him for a lifetime.”

Is Cutting the Male Penis An AIDS Miracle?

 ”If you’re a man, get cut today”

Male circumcision (the cutting of the foreskin from the male penis) is increasingly gaining currency among medical researchers as an alternative method to reduce HIV-infection.

But will this solution really work? 

Researchers say that if all men in sub-Saharan Africa — the worst HIV/AIDS affected region in the world — were circumcised over the next decade, roughly two million new infections and 300 000 deaths could be averted. 

An additional 3.7 million new HIV infections and 2.7 million deaths could be avoided in 20 years.

Put simply, while the benefit of male circumcision to an individual man is immediate, a large scale impact of the intervention will be realized in two decades. 

AIDS risk lowered by 60% 

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 percent the risk of men contracting HIV through sexual intercourse with women. 

The study focused on 3000 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 penile foreskin contains Langerhans cells, which have HIV receptors, and is also vulnerable to 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. 

How will it affect society? 

The evidence that circumcision may protect against HIV infection is now considered strong enough that further trials evaluating the efficacy of circumcision as part of an HIV prevention program have been advocated.

This could herald a new era in HIV-prevention methods. But the question remains: what are the societal implications of such a solution? 

Male circumcision has been practiced extensively in some sub-Saharan communities in rites of passage ceremonies from boyhood to manhood. The gruesome circumstances under which such practices occur may be exacerbated in the light of this new evidence. Other communities have not practiced it at all. 

However, qualitative studies in the Botswana, Haiti, Tanzania, Zambia, and Zimbabwe revealed positive attitudes toward male circumcision in populations that do not traditionally practice it.

From 45 to 85 percent of uncircumcised men in surveys expressed interest in the procedure if it is safe and affordable. In spite of the interest in male circumcision, it is not a magic bullet in the fight against HIV-infection. To be effective, circumcision has to be promoted alongside condom use and faithfulness, long-established approaches in the fight against HIV. 

Education and money will be essential 

Some men may be tempted to engage in unprotected sex because they perceive they are protected by male circumcision. And some women may get a false sense of security when having sex with a circumcised man. 

In itself, male circumcision provides little or no protection against urethral STDs such as gonorrhea and chlamydia and certainly cannot prevent unwanted pregnancies. This issue will need to be strongly emphasized in social campaigns. 

To be successful, male circumcision will have to be complemented by a massive investment into education and counseling programs. There will be need for widespread and culturally sensitive dissemination of information that outlines the benefits and potential complications of male circumcision. 

Another danger is that male circumcision can be risky or fatal if conducted by untrained personnel. There’s no doubt that with increased knowledge of male circumcision as a barrier against HIV, many men will try to perform it on their own.

There will be obviously costs involved in getting circumcised which some people will try to circumvent. Circumcising large numbers of adult men will be a major undertaking. If circumcision is not performed correctly it will increase the risk of infection.

A major surgical system infrastructure needs to be developed. Who will fund this and how long will it take? Also, most health facilities in sub-Saharan Africa are in a shambles and ill-equipped to perform widespread male circumcision.

In addition, there’s also lack of social acceptability of circumcision in many of the sub-Saharan communities that have not traditionally practiced it. Besides the safety and acceptability issues, perhaps the greatest drawback is the financial means required to undertake circumcision whole scale.

Male circumcision will come with high costs through social mobilization efforts and upgrading of medical facilities. The more the men get circumcised, the more the success — and that’s tough ground. 

Imagine the social marketing message: If you’re a man, get cut today.